27 April, 2012
OVERALL
HEMATOLOGY & MEDICAL ONCOLOGY PROGRAM
GOALS AND OBJECTIVES
Overview:
The goals of the University of Wisconsin-Madison Hematology & Medical Oncology
Fellowship Program are that graduates will attain the professional, attitudinal,
cognitive, and technical skills necessary to provide their patients with competent,
compassionate, and patient-centered care. Fellows have many opportunities to learn
and practice patient communication and shared decision making and to apply
current evidence-based knowledge to achieve the best likelihood of the patient's
desired outcome. Fellows are given guidance/mentorship and advice to develop their
careers, achieve scholarship, and complete the prerequisites needed for the next
steps of their careers. Our fellows learn how to problem solve and begin the process
of self-directed life-long learning. Fellows are taught to assess patient outcomes in
order to improve future decision making and guide practice management. They
acquire the ability to organize their workdays, reflect upon and plan for professionalpersonal balance, manage stress, and maintain personal health. The competencies
listed below are achieved through a required set of rotations, a didactic curriculum,
and a self-tailored set of electives. Our fellows, faculty, and program are
continuously evaluated to ensure success in achieving these competencies, goals
and objectives.
Competencies:
In their first year of education, fellows should demonstrate competency in skills
relevant to hematology & oncology for patients with common diagnoses and for
uncomplicated procedures. In their second year fellows should be able to apply
expertise to demonstrate more sophisticated skills with non-routine and complicated
patients and under increasingly difficult circumstances, while also demonstrating
compassionate, appropriate and effective care. As a third year fellow they should be
applying leadership and autonomy in these areas as well as in performing
increasingly complex procedures and handling unexpected complications, while
demonstrating compassion and sensitivity to patient needs and concerns.
Patient Care:
Fellows will be competent to care for patients in all stages of an illness including
those cured who need advice on health promotion and those dying who need
compassionate palliation of discomfort. The fellows will learn to develop evidencebased, patient-centered and tailored treatment plans appropriate to the individual
goals of the patient.
Medical Knowledge:
1
Fellows must demonstrate knowledge of established and evolving biomedical,
clinical, epidemiological and social-behavioral sciences, as well as the application of
this knowledge to patient care.
Formal teaching occurs within the didactic curriculum, but most learning takes place
within clinical experiences. Thus, competence in medical knowledge is inextricably
linked with competence in patient care. In addition to the specialty-specific
knowledge content that is assessed with in-training, and certification board exams, it
is important that each fellow demonstrates his/her ability to acquire and access new
knowledge (i.e., stay up-to-date with the current literature), interpret the information
they uncover, and then apply it in the clinical setting. These are learned skills and
may be applied to other competency domains, especially Practice-based Learning &
Improvement (PBLI) and Systems-based Practice (SBP).
Structured approaches for teaching these skills include journal clubs and critically
appraised topics during specific rotations.
Practice-based Learning and Improvement:
Fellows must demonstrate the ability to investigate and evaluate the care of their
patients, to appraise and assimilate scientific evidence, and to continuously improve
patient care based on constant self-evaluation and life-long learning.
Fellows are expected to develop skills and habits to be able to meet the following
goals:
 identify strengths, deficiencies, and limits in one’s knowledge and
expertise through reflective exercises;
 set learning and improvement goals;
 identify and perform appropriate learning activities;
 systematically analyze practice using quality improvement methods,
and implement changes with the goal of practice improvement
 incorporate formative evaluation feedback into daily practice;
 locate, appraise, and assimilate evidence from scientific studies
related to their patients’ health problems;
 use information technology to optimize learning; and,
 participate in the education of patients, families, students, fellows and
other health professionals.
At the core of proficiency in Practice-based Learning & Improvement (PBLI) is
lifelong learning and quality improvement. These require skills in and the practice of
self evaluation and reflection for quality improvement at the individual practice level,
as well as skills and practice using Evidence-based Medicine (EBM). In addition,
fellows must learn and practice teaching skills to enable them to effectively educate
patients, families, students, fellows and other health professionals.
Interpersonal and Communication Skills:
2
Fellows must demonstrate interpersonal and communication skills that result in the
effective exchange of information and collaboration with patients, their families, and
health professionals.
Fellows are expected to:
 communicate effectively with patients, families, and the public, as
appropriate, across a broad range of socioeconomic and cultural
backgrounds;
 communicate effectively with physicians, other health professionals, and
health related agencies;
 work effectively as a member or leader of a health care team or other
professional group;
 act in a consultative role to other physicians and health professionals;
 maintain comprehensive, timely, and legible medical records.
This competency domain consists of two distinct skill sets, communication skills
(used to perform specific tasks such as obtain a history, obtain informed consent,
telephone triage, present a case, write a consultation note, inform patients of a
diagnosis and therapeutic plan) and interpersonal skills (inherently relational and
process oriented, such as acknowledging emotion, relieving anxiety, and
establishing trusting relationships). The outcome “communicate effectively with
patients, families, and the public…” requires good verbal, non-verbal and written
communication skills, but also requires good relationship-building skills.
A structured curriculum may include both didactics and experiential components for
addressing verbal, non-verbal, and written communication skills. Interactive teaching
methods include structured observed communication sessions followed by feedback,
and small group discussion of vignettes during fellowship meetings. A final but
important area in this competency domain relates to completing and maintaining
comprehensive, timely and legible medical records.
Professionalism:
Fellows must demonstrate a commitment to carrying out professional responsibilities
and an adherence to ethical principles.
Fellows are expected to demonstrate:
 compassion, integrity, and respect for others;
 responsiveness and accountability to patient needs that supersedes selfinterest;
 respect for patient privacy and autonomy;
 the ability to be on time for required meetings and teaching sessions;
 accountability to patient care teams, society and the profession; and
 sensitivity and responsiveness to a diverse patient population, including but
not limited to diversity in gender, age, culture, race, religion, disabilities, and
sexual orientation.
3
Proficiency in this competency domain is demonstrated through behaviors and
attitudes, and is part of all other competency domains. Therefore, teaching and
evaluation is most effective when done in the context of patient care and related
activities (e.g., conducting QI projects, leading a team, presenting M&M, reflections
on practice, conversations with mentors). The major components of professionalism
are commitment, adherence, and sensitivity.
Commitment means respect, altruism, integrity, honesty, compassion, empathy, and
dependability; accountability to patients and society; and professional commitment to
excellence (demonstrated by engaging in activities that foster personal and
professional growth as a physician).
Adherence means accepting responsibility for continuity of care; and practicing
patient-centered care that encompasses confidentiality, respect for privacy and
autonomy through appropriate informed consent and shared decision-making as
relevant to the specialty.
Sensitivity means showing sensitivity to cultural, age, gender and disability issues of
patients as well as of colleagues, including appropriate recognition and response to
physician impairment.
Professionalism, including medical ethics, will be included as a theme throughout the
program curriculum, including both didactic and experiential components and is
modeled by the faculty in clinical practice and discussed with the fellow as issues
arise during their clinical practice.
Systems-based Practice:
Fellows must demonstrate an awareness of and responsiveness to the larger
context and system of health care, and the ability to call effectively on other
resources in the system to provide optimal health care.
Fellows are expected to:
 work effectively in various health care delivery settings and systems relevant
to the practice of hematology and oncology;
 coordinate patient care within the health care system relevant to hematology
and oncology;
 incorporate considerations of cost awareness and risk-benefit analysis in
patient and/or population-based care as appropriate;
 always advocate for quality patient care and optimal patient care systems;
 work in inter-professional teams to enhance patient safety and improve
patient care quality; and,
 participate in identifying system errors and implementing potential systems
solutions.
At the heart of systems-based practice (SBP) is a focus on the broader context of
patient care within the multiple layers of a healthcare system including purchasers
4
(employers, government), insurers (commercial, Medicare, Medicaid), delivery
systems (hospitals, physician networks, drug and technology companies, community
resources), work group (local entity providing care such as a group practice, hospital
service), providers (physicians, nurses, and others both as individuals and teams
that provide direct care), and the users (patients and families). Awareness and
effective use of these resources is important to increase patient care quality, reduce
errors, and control costs.
This competency domain is closely linked to PBLI because it is often through
analysis of one’s practice that system-level opportunities for improvement are
revealed. Fellows must develop abilities in this competency domain not only to
provide safe and effective care, but also to enable them to act as effective
practitioners within a variety of different medical practice/delivery models.
Teamwork skills are important to demonstrating competence in SBP. Participation as
members and leaders of interdisciplinary teams will allow fellows experience to learn
the effective management of a patient-care team.
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27 April 2012
William S. Middleton VA Oncology Clinic
Rotation Goals and Objectives
OVERVIEW:
Each fellow will attend one half-day continuity clinic at the William S. Middleton
Veteran’s Administration Hospital for six months during each of their three years
fellowship training. They may also have elective rotations here during other years of
their training in a non-continuity setting. Each patient visit must be staffed by the
attending physician in the post-clinic wrap up session, led by Dr. Mark Albertini.
During this time, all fellows will present their cases and discuss the plan for care with
supporting evidence. The fellow will be present for all cases seen in the VA clinic
and therefore can not only learn about their own cases, but have obtain a general
sense of care regarding other oncology patients at the VA. All notes need to be
signed by the attending.
The VA Oncology faculty all have general outpatient clinics that care for patients
with a variety of solid tumors. The clinics are usually organized around an
attending MD and a nurse that is usually familiar with the patients seen in the
clinic. There is a “triage” service operated by a rotating group of RN’s that will
field outside calls regarding laboratory values, follow-up schedules, medication
refills and general questions. Calls pertaining to new health issues will be
forwarded to the physician or fellow responsible for the patient when clinically
indicated in the judgment of the RN.
DEFINITIONS:
Continuity clinics:
The fellows will participate in one half-day oncology clinic per week during their
3-year training program. This clinic will exist in solid 6-month blocks and is
deemed the “continuity” clinic. The fellow will attend every week regardless of
the other assignments and will have no excused absences due to ward
responsibilities. The continuity clinic will preferentially be scheduled in the
afternoon to avoid conflict with rounding times on the inpatient service. In this
clinic, the fellow must accrue a group of patients that can be identified by the
continuity with which the patients return to see the fellow. If the fellow perceives
that patients are not returning to their schedule, they should discuss this with the
attending or program director. These clinics serve to provide the fellows with a
cadre of regular patients with regular follow up to help them learn the “ins-andouts” of solid tumor patient care, communication and the delivery of health care
within various systems at the UW.
6
Non-Continuity Clinics:
The fellows will participate in 1 to 4 half-day oncology clinics per week. These
clinics will exist in 1-2-month blocks and are deemed the “non-continuity” clinics.
The fellow will attend every week, but may be excused from these clinics for
competing ward responsibilities. While the fellows may establish a cadre of
regular follow-up patients during these blocks that is not the focus of these
clinics. These clinics serve to further the exposure to different types of solid
tumors based on organ system.
GENERAL DESCRIPTION OF RESPONSIBILITIES:
Each fellow will be assigned to an attending physician’s clinic and all patient
visits to the fellow in clinic will be staffed by that physician. The attending
physicians have clinics organized by their own clinical and research interests. A
fellow will find the experiences in different clinics to vary greatly with respect to
the types of diagnoses seen. For this reason, all fellows will be rotated through
different UW faculty member clinics during their fellowship.
The fellow should assume primary responsibility for all patients they see in their
clinic. In addition to patient encounters, the duties include: dictating all physician
visits, writing chemotherapy orders, calling patients with lab results, following up
on diagnostic tests, discussing issues with family, etc. Essentially, the fellow
should assume all responsibilities required to effectively care for the outpatient
and facilitate transitions between inpatient and outpatient care. Each patient visit
should be staffed by the attending physician. The attending should see all
patients in clinic as they are ultimately responsible for their care. All dictations
need to be co-signed by the attending. The charge codes are required to be
completed by the attending, but the fellow should discuss the various charges
and should be aware of the connection between the service provided and the
charges applied.
OVERALL GOALS FOR THE ROTATION:
Fellows are expected to achieve the milestones listed below and to show
continued growth during each year of training; expected milestones are
discussed in more detail in the following section and are broken down by year in
training.
 To become adept at:
o Forming an organized approach in the diagnosis.
o Interpretation of test results.
o Medical management of varied solid tumor diseases.
 To become adept at the ability to integrate clinical, radiographic, and
laboratory data to generate a differential diagnosis for a patient with a
solid tumor.
 To become adept at the ability to use the accepted staging and
prognosticating tools available for solid tumor malignancies for
determining appropriate treatment.
7

To become an effective communicator with patients and patients’ families
regarding important aspects of a solid tumor diagnosis not limited to:
o Discussing a new diagnosis.
o Delivery of “bad news.”
o Discussion of disease recurrence or progression.
o Discussion of transition to end-of-life care.
o To become adept at the ability to communicate in a respectful and
effective manner, the treatment options appropriate for the patient’s
unique circumstance.
o
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
Oncology patients to achieve competence in the outpatient setting.
 In their first year in the Clinics:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Oncology care. Attending MD’s will guide the
fellows during this year in the appropriate use of evidence-based
care guidelines and the literature in developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
expected to develop competence in the application of their
supervisory skills by involvement in and overseeing the education
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
8
Core competencies:
Patient Care
The fellow will:
 Learn competence in an organized approach in the medical management
of a variety of solid tumors.
 Learn competence in an ability to integrate lab clinical data, pathology
results, and radiographic data to accurately diagnose and evaluate
patients with a solid tumor malignancy.
 Learn competence in the prescription and administration of
chemotherapeutic agents.
 Learn competence in recognizing and understanding the side effect
profiles of various chemotherapeutic agents.
 Learn competence in the performance of appropriate oncology-based
procedures; e.g., intrathecal chemotherapy administration.
 Learn competence in the ability to function as a member of a team to
provide appropriate support to patients with solid tumors.
Medical Knowledge
The fellow will:
 Demonstrate competence in the ability to describe the basic principles of a
variety of oncologic neoplasms and learn to effectively use this knowledge
to come up with an evidence-based treatment plan, searching sources for
evidence to support the fellow’s decision.
 Demonstrate competence in the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies for determining
appropriate treatment.
 Demonstrate competence in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Actively engaging their attending MD’s to verbalize their own unique
learning needs in the pursuit of oncologic learning specific to the patient
profile to which they have been exposed.
 Actively reviewing the electronic notes the fellow has written with the
attending physician to ensure they are complete, accurate, and entail a
thorough plan of care.
 Actively reflecting on their own clinical practice in order to identify areas
for improvement.
9


Critically appraising the literature for a given solid tumor and to incorporate
it into their practice and decision-making.
Actively describing, explaining and clarifying a problem and identifying and
incorporating new information in order to better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
William S. Middleton Veteran’s Administration Hospital oncology clinic.
 Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
 Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Demonstrate competence in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the first year will regularly be
observed and the encounter evaluated by the attending MD in
which the fellow obtains consent for treatment. After the
observation, the fellow should discuss with the attending the
encounter and any opportunities for improvement. These
encounters will be evaluated at the end of a 6 month period.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively in the outpatient clinic with all members of the healthcare team,
and fulfill stated promises and obligations to patients and staff (OCRN,
pharmacist, scheduler, medical assistant, triage, and patients).
 Demonstrate the ability to develop as a leader and a role-model for the
learner members of the treatment team (i.e., medical students and
residents).
 Demonstrate competence in the ability to become an effective educator of
learners on the team.
10

Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Demonstrate competence in the prescription and administration of
chemotherapeutic agents.
 Demonstrate competence in the ability to work effectively in the outpatient
clinic with all members of the healthcare team, and fulfill stated promises
and obligations to patients (OCRN, pharmacist, scheduler, medical
assistant, triage, patients).
 Demonstrate competence in the ability to work effectively in the William S.
Middleton Veteran’s Administration Hospital outpatient o0ncology clinic with
all members of the healthcare team in the quality improvement of care in
the outpatient setting. (E.g., participation on the Chemotherapy Council).
 Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Demonstrate competence in the ability to effectively engage personnel
and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.
MILESTONES BY YEAR OF TRAINING--Year 2.
General Overview:
 As a second year learner, the fellow will work on applying the
fundamentals of outpatient care of Oncology patients.
 In their second year in the Clinics:
o Conditional Independence: Fellows are expected to be learning
more independence in their care of patients in their second year,
but still under the supervision of their attending MD’s. During this
year that they are applying the skills learned in their first year
towards more advanced Oncology care. Attending MD’s will expect
the fellows during this year to present evidence-based care
guidelines from the literature before developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will begin to have a more direct
supervisory role in their second year. They are expected to begin to
apply their supervisory skills and direct the education of residents
11
and medical students on the service. They will be expected to help
residents learn the methods best suited for evidence based care
and learning which they themselves learned in their first year of
fellowship. They will be guided in this development by the attending
MD’s.
Core competencies:
Patient Care
The fellow will be able to:
 Apply expertise to an organized approach in the medical management of a
variety of solid tumors.
 Apply expertise to an ability to integrate lab clinical data, pathology results,
and radiographic data to accurately diagnose and evaluate patients with a
solid tumor malignancy.
 Apply expertise to competence in the prescription and administration of
chemotherapeutic agents.
 Apply expertise to competence in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply expertise to competence in the performance of appropriate
oncology based procedures; e.g., intrathecal chemotherapy
administration.
 Apply expertise to the ability to function as a member of a team to provide
appropriate support to patients with solid tumors.
Medical Knowledge
The fellow will:
 Apply expertise to describe the basic principles of a variety of oncologic
neoplasms and learn to effectively use this knowledge to come up with an
evidence-based treatment plan, searching sources for evidence to support
the fellow’s decision.
 Apply expertise to the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies for determining
appropriate treatment.
 Apply expertise to the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will:
12





Apply expertise to actively engage their attending MD’s to verbalize their
own unique learning needs in the pursuit of oncologic learning specific to
the patient profile to which they have been exposed.
Apply expertise to review the electronic notes the fellow has written with
the attending physician to ensure they are complete, accurate, and entail
a thorough plan of care.
Apply expertise to demonstrate the ability to reflect on their own clinical
practice in order to identify areas for improvement.
Apply expertise to demonstrate the capability to critically appraise the
literature for a given solid tumor and to incorporate it into their practice and
decision-making.
Apply expertise to demonstrate the ability to describe, explain and clarify a
problem and to identify and incorporate new information to optimize
patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply expertise to demonstrate the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Apply expertise to demonstrate the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Apply expertise to maintain an appropriate level of professionalism with
the staff, midlevel providers and physicians in the William S. Middleton
Veteran’s Administration Hospital oncology clinic.
 Apply expertise to demonstrate the ability to manage areas of conflict and
to negotiate appropriate resolutions to these challenges.
 Apply expertise to demonstrate the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Apply expertise to satisfactorily discuss a chemotherapy treatment plan
with a patient incorporating the process of informed consent.
o It is expected that fellows during the second year will be competent
to obtain consent for treatment for their patient population. The
fellow will continue to discuss the encounter with the attending and
any opportunities for improvement.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively in the
outpatient clinic with all members of the healthcare team, and fulfill stated
promises and obligations to patients and staff (OCRN, pharmacist,
scheduler, medical assistant, triage, and patients).
13



Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
Apply expertise in the ability to become an effective educator of learners
on the team.
Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
Systems-Based Practice
The fellow will:
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in the ability to work effectively in the William S. Middleton
Veteran’s Administration Hospital outpatient oncology clinic with all
members of the healthcare team, and fulfill stated promises and
obligations to patients (OCRN, pharmacist, scheduler, medical assistant,
triage, patients).
 Apply expertise in the ability to work effectively in the outpatient clinic with
all members of the healthcare team in the quality improvement of care in
the outpatient setting. (E.g., participation on the Chemotherapy Council).
 Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
 Apply expertise in the ability to effectively engage personnel and programs
(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.
MILESTONES BY YEAR OF TRAINING--Year 3.
General Overview:
 As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of outpatient care of Oncology
patients, relying on the attending for expertise and guidance.
 In their third year in the Clinics:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology care. Attending MD’s will expect the fellows during this
year to present evidence-based care guidelines from the literature
and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
14
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
learn the art of designating responsibilities for patients’ care to the
various team members. They will be guided in this development by
the attending MD’s.
Core competencies:
Patient Care
The fellow will be able to:
 Apply leadership and autonomy to an organized approach in the medical
management of a variety of solid tumors.
 Apply leadership and autonomy to an ability to integrate lab clinical data,
pathology results, and radiographic data to accurately diagnose and
evaluate patients with a solid tumor malignancy.
 Apply leadership and autonomy to competence in the prescription and
administration of chemotherapeutic agents.
 Apply leadership and autonomy in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply leadership and autonomy in the performance of appropriate
oncology based procedures; e.g., intrathecal chemotherapy
administration.
 Apply leadership and autonomy in the ability to function as a member of a
team to provide appropriate support to patients with solid tumors.
Medical Knowledge
The fellow will:
 Apply leadership and autonomy to describe the basic principles of a
variety of oncologic neoplasms and learn to effectively use this knowledge
to come up with an evidence-based treatment plan, searching sources for
evidence to support the fellow’s decision.
 Apply leadership and autonomy to the ability to use the accepted staging
and prognosticating tools available for oncologic malignancies for
determining appropriate treatment.
15


Apply leadership and autonomy to the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will:
 Apply leadership and autonomy to actively engage their attending MD’s to
verbalize their own unique learning needs in the pursuit of oncologic
learning specific to the patient profile to which they have been exposed.
 Apply leadership and autonomy in the review of the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Apply leadership and autonomy to demonstrate the ability to reflect on
their own clinical practice in order to identify areas for improvement.
 Apply leadership and autonomy to demonstrate the capability to critically
appraise the literature for a given solid tumor and to incorporate it into
their practice and decision-making.
 Apply leadership and autonomy to demonstrate the ability to describe,
explain and clarify a problem and to identify and incorporate new
information to optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply leadership and autonomy to demonstrate the ability to interact in an
appropriate therapeutic relationship with patients and families.
 Apply leadership and autonomy to demonstrate the ability to effectively
communicate with patients regarding all aspects of their care including a
new diagnosis, relapse or transition to end-of-life care.
 Apply leadership and autonomy to maintain an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
William S. Middleton Veteran’s Administration Hospital oncology clinic.
 Apply leadership and autonomy to demonstrate the ability to manage
areas of conflict and to negotiate appropriate resolutions to these
challenges.
 Apply leadership and autonomy to demonstrate the ability to give critical
and praiseworthy feedback to subordinate learners to help those learners
along their paths.
 Apply leadership and autonomy to satisfactorily discuss a chemotherapy
treatment plan with a patient incorporating the process of informed
consent.
16
o It is expected that fellows during the third year will be independent
and will apply autonomous leadership to obtain consent for
treatment for their patient population. The fellow will continue to
utilize the attending MD for guidance and support.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply leadership and autonomy in the ability to work and communicate
effectively in the outpatient clinic with all members of the healthcare team,
and fulfill stated promises and obligations to patients and staff (OCRN,
pharmacist, scheduler, medical assistant, triage, and patients).
 Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
 Apply leadership and autonomy in the ability to become an effective
educator of learners on the team.
 Apply leadership and autonomy in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
 Apply leadership and autonomy in the ability to work effectively in the
William S. Middleton Veteran’s Administration Hospital outpatient clinic with
all members of the healthcare team, and fulfill stated promises and
obligations to patients (OCRN, pharmacist, scheduler, medical assistant,
triage, patients).
 Apply leadership and autonomy in the ability to work effectively in the
outpatient clinic with all members of the healthcare team in the quality
improvement of care in the outpatient setting. (E.g., participation on the
Chemotherapy Council).
 Apply leadership and autonomy in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Apply leadership and autonomy in the ability to effectively engage
personnel and programs (i.e., nursing, social work, physical therapy, home
health care, etc.) necessary to provide optimal patient care.
Contacts for this Rotation:
Mark Albertini, Director of Oncology, Middleton Veterans Administration Hospital. Phone: 2630017
17
Administrative Contacts: Pat Thiede, Deb Hurst, Jackie Wheeler, RN. Phone: 256-1901, ext
17017
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
Clinic Manager: Susan Hanauer, R.N. 3-8266
Chemo Coordinator: Ellen Donehower, R.N. 3-8251
Clinic Secretary/Lead Worker: Peggy Harms, 3-9552
Other Info: Appointment Desk: 5-1700
Clinic Nurses Station: 5-0093
Nurse Triage 5-9986
Pharmacy 2-3421
18
27 April 2012
William S. Middleton VA Hematology Clinic
Rotation Goals and Objectives
OVERVIEW:
Each fellow will attend one half-day continuity clinic at the William S. Middleton
Veteran’s Administration Hospital for six months during each of their three years of
fellowship. They may also have elective rotations here during other years of their
training in a non-continuity setting. Each patient visit must be staffed by the
attending physician in the post-clinic wrap up session, led by Dr. Liz Silverman or
Natalie Callander. During this time, all fellows will present their cases and discuss
the plan for care with supporting evidence. The fellow will be present for all cases
seen in the VA clinic and therefore can not only learn about their own cases, but
have obtain a general sense of care regarding other oncology patients at the VA. All
notes need to be signed by the attending.
The VA Hematology faculty all have general outpatient clinics that care for
patients with a variety of benign or malignant hematologic illnesses. The clinics
are usually organized around an attending MD and a nurse that is usually familiar
with patients seen in the clinic. There is a “triage” service operated by a rotating
group of RN’s that will field outside calls regarding laboratory values, follow-up
schedules, medication refills and general questions. Calls pertaining to new
health issues will be forwarded to the physician or fellow responsible for the
patient when clinically indicated in the judgment of the RN.
DEFINITIONS:
Continuity clinics:
The fellows will participate in one half-day hematology clinic per week. This clinic
will exist in solid 6-month blocks and is deemed the “continuity” clinic. The fellow
will attend every week regardless of the other assignments and will have no
excused absences due to ward responsibilities. The continuity clinic may be a
UW or VA clinic and will preferentially be scheduled in the afternoon when
possible to avoid conflict with rounding times on the inpatient service. In this
clinic, the fellow must accrue a group of patients that can be identified by the
continuity with which the patients return to see the fellow. If the fellow perceives
that patients are not returning to their schedule, they should discuss this with the
attending or program director. These clinics serve to provide the fellows with a
cadre of regular patients with regular follow up to help them learn the “ins-andouts” of hematologic patient care, communication and the delivery of health care
within various systems at the UW.
Non-Continuity Clinics:
19
The fellows will participate in 1 to 4 half-day clinics per week that will include
oncology or hematology disciplines, depending on their year in training. These
clinics will exist in 1-2-month blocks and are deemed the “non-continuity” clinics.
The fellow will attend every week, but will be excused from these clinics for
competing ward responsibilities. The non-continuity clinic may be a UW or VA
clinic and will preferentially be scheduled in the afternoon to avoid conflict with
rounding times on the inpatient service. While the fellows may establish a cadre
of regular follow-up patients during these blocks that is not the focus of these
clinics. These clinics serve to further the exposure to different types of solid
tumors based on organ system.
GENERAL DESCRIPTION OF RESPONSIBILITIES:
Each fellow will be assigned to an attending physician’s clinic and all patient
visits to the fellow in clinic will be staffed by that physician. The fellow should
assume primary responsibility for all patients they see in their clinic. In addition to
patient encounters, the duties include: dictating all physician visits, writing
chemotherapy orders, calling patients with lab results, following up on diagnostic
tests, discussing issues with family, etc. Essentially, the fellow should assume all
responsibilities required to effectively care for the outpatient and facilitate
transitions between inpatient and outpatient care. Each patient visit should be
staffed by the attending physician. The attending should see all patients in clinic
as they are ultimately responsible for their care. All dictations need to be cosigned by the attending. The charge codes are required to be completed by the
attending, but the fellow should discuss the various charges and should be aware
of the connection between the service provided and the charges applied.
OVERALL GOALS FOR THE ROTATION:
Fellows are expected to achieve the milestones listed below and to show
continued growth during each year of training; expected milestones are
discussed in more detail in the following section and are broken down by year in
training.
 To become adept at:
o Forming an organized approach in the diagnosis.
o Interpretation of test results.
o Interpretation of the peripheral blood smear
o Medical management of varied benign and malignant hematologic
diseases.
 To become adept at the ability to integrate clinical, radiographic, and
laboratory data to generate a differential diagnosis for a patient with varied
hematologic illnesses.
 To become adept at the ability to use the accepted staging and
prognosticating tools available for benign and malignant hematologic
diseases for determining appropriate treatment.
20

To become an effective communicator with patients and patients’ families
regarding important aspects of a hematologic diagnosis not limited to:
o Discussing a new diagnosis.
o Delivery of “bad news.”
o Discussion of disease recurrence or progression.
o Discussion of transition to end-of-life care.
o To become adept at the ability to communicate in a respectful and
effective manner, the treatment options appropriate for the patient’s
unique circumstance.
o
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
Oncology patients to achieve competence in the outpatient setting.
 In their first year in the Clinics:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Hematology care. Attending MD’s will guide
the fellows during this year in the appropriate use of evidencebased care guidelines and the literature in developing plans for
their patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
expected to develop competence in the application of their
supervisory skills by involvement in and overseeing the education
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
21
Core competencies:
Patient Care
The fellow will:
 Learn competence in an organized approach in the medical management
of a variety of benign and malignant hematologic illnesses.
 Learn competence in an ability to integrate lab clinical data, pathology
results, and radiographic data to accurately diagnose and evaluate
patients with benign and malignant hematologic illnesses.
 Learn competence in the prescription and administration of
chemotherapeutic agents.
 Learn competence in recognizing and understanding the side effect
profiles of various chemotherapeutic agents.
 Learn competence in the performance of appropriate hematology-based
procedures; e.g., intrathecal chemotherapy administration and bone
marrow evaluation.
 Learn competence in the ability to function as a member of a team to
provide appropriate support to patients with benign and malignant
hematologic illnesses.
Medical Knowledge
The fellow will:
 Demonstrate competence in the ability to describe the basic principles of a
variety of benign and malignant hematologic illnesses and learn to
effectively use this knowledge to come up with an evidence-based
treatment plan, searching sources for evidence to support the fellow’s
decision.
 Demonstrate competence in the ability to use the accepted staging and
prognosticating tools available for benign and malignant hematologic
illnesses for determining appropriate treatment.
 Demonstrate competence in the ability to interpret a peripheral blood
smear and apply that interpretation in the development of a differential
diagnosis and treatment plan for patients with a variety of benign and
malignant hematologic processes.
 Demonstrate competence in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
 Achieve competent scores on the ASH in-training exam for their level of
training (given in March of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
22





Actively engaging their attending MD’s to verbalize their own unique
learning needs in the pursuit of hematologic learning specific to the patient
profile to which they have been exposed.
Actively reviewing the electronic notes the fellow has written with the
attending physician to ensure they are complete, accurate, and entail a
thorough plan of care.
Actively reflecting on their own clinical practice in order to identify areas
for improvement.
Critically appraising the literature for a given hematologic illness and to
incorporate it into their practice and decision-making.
Actively describing, explaining and clarifying a problem and identifying and
incorporating new information in order to better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
William S. Middleton Veteran’s Administration Hospital hematology clinic.
 Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
 Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Demonstrate competence in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the first year will regularly be
observed and the encounter evaluated by the attending MD in
which the fellow obtains consent for treatment. After the
observation, the fellow should discuss with the attending the
encounter and any opportunities for improvement. These
encounters will be evaluated at the end of a 6 month period.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively in the William S. Middleton VA outpatient hematology clinic with
all members of the healthcare team, and fulfill stated promises and
23



obligations to patients and staff (OCRN, pharmacist, scheduler, medical
assistant, triage, and patients).
Demonstrate the ability to develop as a leader and a role-model for the
learner members of the treatment team (i.e., medical students and
residents).
Demonstrate competence in the ability to become an effective educator of
learners on the team.
Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Demonstrate competence in the prescription and administration of
chemotherapeutic agents.
 Demonstrate competence in the ability to work effectively in the outpatient
clinic with all members of the healthcare team, and fulfill stated promises
and obligations to patients (OCRN, pharmacist, scheduler, medical
assistant, triage, patients).
 Demonstrate competence in the ability to work effectively in the William S.
Middleton Veteran’s Administration Hospital outpatient hematology clinic
with all members of the healthcare team in the quality improvement of
care in the outpatient setting. (E.g., participation on the Chemotherapy
Council).
 Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Demonstrate competence in the ability to effectively engage personnel
and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.
MILESTONES BY YEAR OF TRAINING--Year 2.
General Overview:
 As a second year learner, the fellow will work on applying the
fundamentals of outpatient care of Hematology patients.
 In their second year in the Clinics:
o Conditional Independence: Fellows are expected to be learning
more independence in their care of patients in their second year,
but still under the supervision of their attending MD’s. During this
year that they are applying the skills learned in their first year
towards more advanced Hematology care. Attending MD’s will
expect the fellows during this year to present evidence-based care
24
guidelines from the literature before developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will begin to have a more direct
supervisory role in their second year. They are expected to begin to
apply their supervisory skills and direct the education of residents
and medical students on the service. They will be expected to help
residents learn the methods best suited for evidence based care
and learning which they themselves learned in their first year of
fellowship. They will be guided in this development by the attending
MD’s.
Core competencies:
Patient Care
The fellow will be able to:
 Apply expertise to an organized approach in the medical management of a
variety of benign and malignant hematologic illnesses.
 Apply expertise to an ability to integrate lab clinical data, pathology results,
and radiographic data to accurately diagnose and evaluate patients with
benign and malignant hematologic illnesses.
 Apply expertise to competence in the prescription and administration of
chemotherapeutic agents.
 Apply expertise to competence in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply expertise to competence in the performance of appropriate
hematology based procedures; e.g., intrathecal chemotherapy
administration and bone marrow evaluation.
 Apply expertise to the ability to function as a member of a team to provide
appropriate support to patients with benign and malignant hematologic
illnesses.
Medical Knowledge
The fellow will:
 Apply expertise to describe the basic principles of a variety of benign and
malignant hematologic illnesses and learn to effectively use this
knowledge to come up with an evidence-based treatment plan, searching
sources for evidence to support the fellow’s decision.
 Apply expertise to the ability to use the accepted staging and
prognosticating tools available for benign and malignant hematologic
illnesses for determining appropriate treatment.
25



Apply expertise in the ability to interpret a peripheral blood smear and
apply that interpretation in the development of a differential diagnosis and
treatment plan for patients with a variety of benign and malignant
hematologic processes.
Apply expertise to the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
Achieve competent scores on the ASH in-training exam for their level of
training (given in March of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will:
 Apply expertise to actively engage their attending MD’s to verbalize their
own unique learning needs in the pursuit of hematologic learning specific
to the patient profile to which they have been exposed.
 Apply expertise to review the electronic notes the fellow has written with
the attending physician to ensure they are complete, accurate, and entail
a thorough plan of care.
 Apply expertise to demonstrate the ability to reflect on their own clinical
practice in order to identify areas for improvement.
 Apply expertise to demonstrate the capability to critically appraise the
literature for a given hematologic illness and to incorporate it into their
practice and decision-making.
 Apply expertise to demonstrate the ability to describe, explain and clarify a
problem and to identify and incorporate new information to optimize
patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply expertise to demonstrate the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Apply expertise to demonstrate the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Apply expertise to maintain an appropriate level of professionalism with
the staff, midlevel providers and physicians in the William S. Middleton
Veteran’s Administration Hospital hematology clinic.
 Apply expertise to demonstrate the ability to manage areas of conflict and
to negotiate appropriate resolutions to these challenges.
 Apply expertise to demonstrate the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Apply expertise to satisfactorily discuss a chemotherapy treatment plan
with a patient incorporating the process of informed consent.
26
o It is expected that fellows during the second year will be competent
to obtain consent for treatment for their patient population. The
fellow will continue to discuss the encounter with the attending and
any opportunities for improvement.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively in the
William S. Middleton outpatient hematology clinic with all members of the
healthcare team, and fulfill stated promises and obligations to patients and
staff (OCRN, pharmacist, scheduler, medical assistant, triage, and
patients).
 Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
 Apply expertise in the ability to become an effective educator of learners
on the team.
 Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
Systems-Based Practice
The fellow will:
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in the ability to work effectively in the William S. Middleton
Veteran’s Administration Hospital outpatient hematology clinic with all
members of the healthcare team, and fulfill stated promises and
obligations to patients (OCRN, pharmacist, scheduler, medical assistant,
triage, patients).
 Apply expertise in the ability to work effectively in the William S. Middleton
outpatient hematology clinic with all members of the healthcare team in
the quality improvement of care in the outpatient setting. (E.g.,
participation on the Chemotherapy Council).
 Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
 Apply expertise in the ability to effectively engage personnel and programs
(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.
MILESTONES BY YEAR OF TRAINING--Year 3.
General Overview:
27


As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of outpatient care of Hematology
patients, relying on the attending for expertise and guidance.
In their third year in the Clinics:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology care. Attending MD’s will expect the fellows during this
year to present evidence-based care guidelines from the literature
and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
learn the art of designating responsibilities for patients’ care to the
various team members. They will be guided in this development by
the attending MD’s.
Core competencies:
Patient Care
The fellow will be able to:
 Apply leadership and autonomy to an organized approach in the medical
management of a variety of benign and malignant hematologic illnesses.
 Apply leadership and autonomy to an ability to integrate lab clinical data,
pathology results, and radiographic data to accurately diagnose and
evaluate patients with benign and malignant hematologic illnesses.
 Apply leadership and autonomy to competence in the prescription and
administration of chemotherapeutic agents.
 Apply leadership and autonomy in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply leadership and autonomy in the performance of appropriate
hematology based procedures; e.g., intrathecal chemotherapy
administration and bone marrow evaluation.
28

Apply leadership and autonomy in the ability to function as a member of a
team to provide appropriate support to patients with benign and malignant
hematologic illnesses.
Medical Knowledge
The fellow will:
 Apply leadership and autonomy to describe the basic principles of a
variety of hematologic illnesses and learn to effectively use this knowledge
to come up with an evidence-based treatment plan, searching sources for
evidence to support the fellow’s decision.
 Apply leadership and autonomy to the ability to use the accepted staging
and prognosticating tools available for benign and malignant hematologic
illnesses for determining appropriate treatment.
 Apply leadership and autonomy in the ability to interpret a peripheral blood
smear and apply that interpretation in the development of a differential
diagnosis and treatment plan for patients with a variety of benign and
malignant hematologic processes.
 Apply leadership and autonomy to the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
 Achieve competent scores on the ASH in-training exam for their level of
training (given in March of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will:
 Apply leadership and autonomy to actively engage their attending MD’s to
verbalize their own unique learning needs in the pursuit of hematologic
learning specific to the patient profile to which they have been exposed.
 Apply leadership and autonomy in the review of the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Apply leadership and autonomy to demonstrate the ability to reflect on
their own clinical practice in order to identify areas for improvement.
 Apply leadership and autonomy to demonstrate the capability to critically
appraise the literature for a given hematologic illness and to incorporate it
into their practice and decision-making.
 Apply leadership and autonomy to demonstrate the ability to describe,
explain and clarify a problem and to identify and incorporate new
information to optimize patient care.
Interpersonal and Communication Skills
The fellow will:
29






Apply leadership and autonomy to demonstrate the ability to interact in an
appropriate therapeutic relationship with patients and families.
Apply leadership and autonomy to demonstrate the ability to effectively
communicate with patients regarding all aspects of their care including a
new diagnosis, relapse or transition to end-of-life care.
Apply leadership and autonomy to maintain an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
William S. Middleton Veteran’s Administration Hospital hematology clinic.
Apply leadership and autonomy to demonstrate the ability to manage
areas of conflict and to negotiate appropriate resolutions to these
challenges.
Apply leadership and autonomy to demonstrate the ability to give critical
and praiseworthy feedback to subordinate learners to help those learners
along their paths.
Apply leadership and autonomy to satisfactorily discuss a chemotherapy
treatment plan with a patient incorporating the process of informed
consent.
o It is expected that fellows during the third year will be independent
and will apply autonomous leadership to obtain consent for
treatment for their patient population. The fellow will continue to
utilize the attending MD for guidance and support.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply leadership and autonomy in the ability to work and communicate
effectively in the William S. Middleton VA outpatient hematology clinic with
all members of the healthcare team, and fulfill stated promises and
obligations to patients and staff (OCRN, pharmacist, scheduler, medical
assistant, triage, and patients).
 Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
 Apply leadership and autonomy in the ability to become an effective
educator of learners on the team.
 Apply leadership and autonomy in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
30




Apply leadership and autonomy in the ability to work effectively in the
William S. Middleton Veteran’s Administration Hospital outpatient
hematology clinic with all members of the healthcare team, and fulfill
stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
Apply leadership and autonomy in the ability to work effectively in the
William S. Middleton outpatient hematology clinic with all members of the
healthcare team in the quality improvement of care in the outpatient
setting. (E.g., participation on the Chemotherapy Council).
Apply leadership and autonomy in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
Apply leadership and autonomy in the ability to effectively engage
personnel and programs (i.e., nursing, social work, physical therapy, home
health care, etc.) necessary to provide optimal patient care.
Contacts for this Rotation:
Mark Albertini, Director of Oncology, Middleton Veterans Administration Hospital. Phone: 2630017
Administrative Contacts: Pat Thiede, Deb Hurst, Jackie Wheeler, RN. Phone: 256-1901, ext
17017
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
Clinic Manager: Susan Hanauer, R.N. 3-8266
Chemo Coordinator: Ellen Donehower, R.N. 3-8251
Clinic Secretary/Lead Worker: Peggy Harms, 3-9552
Other Info: Appointment Desk: 5-1700
Clinic Nurses Station: 5-0093
Nurse Triage 5-9986
Pharmacy 2-3421
31
27 April 2012
UW Palliative Care Ward and Consult Service
Rotation
Goals and Objectives
OVERVIEW:
Hospice and palliative medicine is comprehensive, interdisciplinary care for patients
with advanced, progressive, life-threatening illnesses; this model of care is referred
to as palliative care. The nature of palliative medicine includes the provision of
family-centered care that is necessary to support the quality of life for the patient.
The discipline and model of care aim to help patients and their families achieve the
best possible quality of life throughout the course of a life-threatening illness by
preventing and relieving suffering, controlling symptoms, providing psychosocial
support and preserving opportunities for personal and family development. Palliative
care includes a potential role in the co-management of patients at all stages of
disease and in the presence of restorative, curative, and life-prolonging goals.
GENERAL DESCRIPTION OF RESPONSIBILITIES:
Integral to the provision of multi-dimensional care for patients suffering physically,
spiritually and cognitively is the interdisciplinary palliative care team composed of
physicians, nurses, social workers, chaplains and others. Fellows rotating on the
palliative care service and consults will attend daily interdisciplinary team rounds
Monday-Friday and will be the primary spokesperson for the physician perspective.
In this interdisciplinary team setting, the patient’s primary nurse leads the discussion,
introducing the patient and updating the team on active issues. All disciplines then
provide their perspective. The fellow will have graduated responsibility to act as the
attending physician during interdisciplinary team meetings according to their
development and comfort level. They will interact with all members to generate a
comprehensive plan and then write orders as necessary to enact the plan. They will
also provide a leading role in the team process by engaging in quality improvement
activities to maximize the efficiency and effectiveness of the team meeting. The
fellow interacts with the consult service and acts as liaison to inform the inpatient
team about new transfers to the unit. The fellow also sees consultations with
members of the team, leading the implementation of palliative care goals that may
include discharge from the hospital or transfer to the Palliative Care unit, where they
will assume the care of the patients under the supervision of faculty.
OVERALL GOALS FOR THE ROTATION:
Fellows are expected to achieve the milestones listed below and to show
continued growth during each year of training; expected milestones are
discussed in more detail in the following section and are broken down by year in
training.
32



To become proficient in acute management of palliative care patients who
may or may not have a terminal condition.
To become an effective leader of an interdisciplinary team of a palliative care
providers.
To become an effective communicator with patients and patients’ families
regarding important aspects of a solid tumor diagnosis not limited to:
o Discussing a new diagnosis.
o Delivery of “bad news.”
o Discussion of disease recurrence or progression.
o Discussion of transition to end-of-life care.
o
To become adept at the ability to communicate in a respectful and
effective manner, the treatment options appropriate for the patient’s
unique circumstance.
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
Palliative Care to achieve competence in the inpatient and consult setting.
 In their first year on the service:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Oncology care. Attending MD’s will guide the
fellows during this year in the appropriate use of evidence-based
care guidelines and the literature in developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
expected to develop competence in the application of their
supervisory skills by involvement in and overseeing the education
33
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
Core competencies:
Patient and Family Care
The fellow will:
 Learn competence in gathering comprehensive and accurate information
from all pertinent sources, including patient, family members, health care
proxies, other health care providers, interdisciplinary team members and
medical records.
o Obtains a comprehensive medical history including:
 Patient understanding of illness and prognosis.
 Goals of care/advance care planning/proxy decision-making.
 Detailed symptom history.
 Psychosocial and coping history including loss history.
 Quality of life assessment.
 Depression evaluation (including stressors and areas of major
concern).
 Pharmacologic history including substance dependency or
abuse.
 Detailed neurological exam, including mental status exam.
 Learn competence in the ability to synthesize and apply information in the
clinical setting by:
o Developing a prioritized differential diagnosis and problem list.
o Developing recommendations based on patient and family values.
 Learn competence in the management physical symptoms, psychological
issues, social stressors, and spiritual dimensions of care for the patient and
family by:
o Assessing pain and non-pain symptoms.
o The use of opioid and non-opioid pharmacologic options.
o The use of non-pharmacologic symptom interventions.
o The management of neuropsychiatric disorders.
o The management of physical symptoms and psychosocial distress in
the patient and family.
o The re-assessment of symptoms frequently, and making of therapeutic
adjustments as needed.
 Learn competence by demonstrating the use of the interdisciplinary approach
to develop a care plan that optimizes patient and family goals and reduces
suffering
 Learn competence by the assessment of and communication of prognosis.
Medical Knowledge
The fellow will:
34



Demonstrate competence in the ability to assess and communicate
prognosis:
o Identifies what elements of the patient’s history and physical
examination are critical to formulating prognosis for a given patient.
o Describes common chronic illnesses with prognostic factors, expected
natural course and trajectories, common treatments, and
complications.
o Describes effective strategies to communicate prognostic information
to patients, families, and health care providers.
o Recognize the presentation of common life-limiting illnesses,
syndromes, and their common complications.
Demonstrate competence in the ability to describe pharmacologic
approaches to the management of common pain AND non-pain symptoms:
o Describes use of common agents used to treat dyspnea, nausea,
vomiting, diarrhea, constipation, anxiety, depression, fatigue, pruritus,
confusion, agitation, and other common problems in palliative care
practice
Demonstrate competence in describing the ethical and legal issues in
palliative care and their clinical management
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Demonstrate competence by actively engaging their attending MD’s to
verbalize their own unique learning needs in the pursuit of palliative care
learning specific to the patient profile to which they have been exposed.
 Demonstrate competence by actively reviewing the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Demonstrate competence by actively reflecting on their own clinical
practice in order to identify areas for improvement.
 Demonstrate competence by critically appraising the literature for a given
solid tumor and to incorporate it into their practice and decision-making.
 Demonstrate competence by actively describing, explaining and clarifying
a problem and identifying and incorporating new information in order to
better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to initiate informed relationshipcentered dialogues about care:
o Assesses patient/family wishes regarding the amount of information
they wish to receive and the extent to which they want to participate in
clinical decision-making.
o Assesses patient’s and family members’ decision-making capacity,
and other strengths and limitations of understanding and
communication.
35






o Enlists legal surrogates to speak on behalf of a patient when making
decisions for a patient without decision-making capacity.
Demonstrate competence in the ability to demonstrates empathy:
o Uses empathic and facilitating verbal behaviors such as: naming,
affirmation, normalization, reflection, silence, listening, self-disclosure,
and humor in an effective and appropriate manner.
o Demonstrates ability to recognize and respond to own emotions and
those of others.
o Expresses awareness of own emotional state before, during, and after
patient and family encounters.
o Self-corrects communication miscues.
o Processes own emotions in a clinical setting in order to focus on the
needs of the patient and family.
o Responds effectively to intense emotions of patients, families and
colleagues.
Demonstrate competence in the ability to educate patients/families about
the medical, social and psychological issues associated with life-limiting
illness.
Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians on the
UW Palliative Care Ward and Consult service.
Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively on the UW Palliative Care Ward and Consult service with all
members of the healthcare team, and fulfill stated promises and
obligations to patients and staff (OCRN, pharmacist, scheduler, medical
assistant, triage, and patients).
 Demonstrate the ability to develop as a leader and a role-model for the
learner members of the treatment team (i.e., medical students and
residents).
 Demonstrate competence in the ability to become an effective educator of
learners on the team.
 Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
 Demonstrate competence in the ability to achieve balance between the
needs of patients/family/team, while balancing one’s own need for self-care.
36


Demonstrate competence in the ability show accountability to patients,
society, and the profession; and a commitment to excellence.
Demonstrate competence in the ability to show respect and compassion
towards all patients and their families, as well as towards other clinicians.
Systems-Based Practice
The fellow will:
 Demonstrate competence in the ability to describe the various funding
mechanisms for hospice and palliative care and develop appropriate plans of
care in this context.
 Demonstrate competence in the ability to collaborate effectively with all the
various institutional providers of hospice and palliative care while advocating
for patients and families.
 Demonstrate competence in the ability to advocate for quality patient and
family care, and assists patients and families in dealing with system
complexities.
 Demonstrate competence in the ability to work effectively on the UW
Palliative Care Ward and Consult service with all members of the
healthcare team, and fulfill stated promises and obligations to patients
(OCRN, pharmacist, scheduler, medical assistant, triage, patients).
 Demonstrate competence in the ability to work effectively on the UW
Palliative Care Ward and Consult service with all members of the
healthcare team in the quality improvement of care in the outpatient
setting. (E.g., participation on the Chemotherapy Council).
 Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Demonstrate competence in the ability to effectively engage personnel




and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.
Demonstrate competence in the ability to lead multidisciplinary health team
rounds.
Demonstrate competence in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Demonstrate competence in the effective triage of night and weekend patient
phone calls that results in appropriate communication to involved parties and
follow-up plans.
Demonstrate competence in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
MILESTONES BY YEAR OF TRAINING--Year 2.
37
General Overview:
 As a second year learner, the fellow will work on applying the
fundamentals of inpatient and consultative care of palliative care patients.
 In their second year in the Clinics:
o Conditional Independence: Fellows are expected to be learning
more independence in their care of patients in their second year,
but still under the supervision of their attending MD’s. During this
year that they are applying the skills learned in their first year
towards more advanced Oncology care. Attending MD’s will expect
the fellows during this year to present evidence-based care
guidelines from the literature before developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will begin to have a more direct
supervisory role in their second year. They are expected to begin to
apply their supervisory skills and direct the education of residents
and medical students on the service. They will be expected to help
residents learn the methods best suited for evidence based care
and learning which they themselves learned in their first year of
fellowship. They will be guided in this development by the attending
MD’s.
Core competencies:
Patient and Family Care
The fellow will:
 Apply expertise in gathering comprehensive and accurate information from
all pertinent sources, including patient, family members, health care proxies,
other health care providers, interdisciplinary team members and medical
records.
o Obtains a comprehensive medical history including:
 Patient understanding of illness and prognosis.
 Goals of care/advance care planning/proxy decision-making.
 Detailed symptom history.
 Psychosocial and coping history including loss history.
 Quality of life assessment.
 Depression evaluation (including stressors and areas of major
concern).
 Pharmacologic history including substance dependency or
abuse.
 Detailed neurological exam, including mental status exam.
 Apply expertise in the ability to synthesize and apply information in the
clinical setting by:
o Developing a prioritized differential diagnosis and problem list.
38



o Developing recommendations based on patient and family values.
Apply expertise in the management physical symptoms, psychological
issues, social stressors, and spiritual dimensions of care for the patient and
family by:
o Assessing pain and non-pain symptoms.
o The use of opioid and non-opioid pharmacologic options.
o The use of non-pharmacologic symptom interventions.
o The management of neuropsychiatric disorders.
o The management of physical symptoms and psychosocial distress in
the patient and family.
o The re-assessment of symptoms frequently, and making of therapeutic
adjustments as needed.
Apply expertise by demonstrating the use of the interdisciplinary approach to
develop a care plan that optimizes patient and family goals and reduces
suffering
Apply expertise by the assessment of and communication of prognosis.
Medical Knowledge
The fellow will:
 Apply expertise in the ability to assess and communicate prognosis:
o Identifies what elements of the patient’s history and physical
examination are critical to formulating prognosis for a given patient.
o Describes common chronic illnesses with prognostic factors, expected
natural course and trajectories, common treatments, and
complications.
o Describes effective strategies to communicate prognostic information
to patients, families, and health care providers.
o Recognize the presentation of common life-limiting illnesses,
syndromes, and their common complications.
 Apply expertise in the ability to describe pharmacologic approaches to the
management of common pain AND non-pain symptoms:
o Describes use of common agents used to treat dyspnea, nausea,
vomiting, diarrhea, constipation, anxiety, depression, fatigue, pruritus,
confusion, agitation, and other common problems in palliative care
practice
 Apply expertise in describing the ethical and legal issues in palliative care
and their clinical management
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Apply expertise in actively engaging their attending MD’s to verbalize their
own unique learning needs in the pursuit of oncologic learning specific to
the patient profile to which they have been exposed.
 Apply expertise in actively reviewing the electronic notes the fellow has
written with the attending physician to ensure they are complete, accurate,
and entail a thorough plan of care.
39



Apply expertise in actively reflecting on their own clinical practice in order
to identify areas for improvement.
Apply expertise in critically appraising the literature for a given solid tumor
and to incorporate it into their practice and decision-making.
Apply expertise in actively describing, explaining and clarifying a problem
and identifying and incorporating new information in order to better
optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply expertise in the ability to initiate informed relationship-centered
dialogues about care:
o Assesses patient/family wishes regarding the amount of information
they wish to receive and the extent to which they want to participate in
clinical decision-making.
o Assesses patient’s and family members’ decision-making capacity,
and other strengths and limitations of understanding and
communication.
o Enlists legal surrogates to speak on behalf of a patient when making
decisions for a patient without decision-making capacity.
 Apply expertise in the ability to demonstrates empathy:
o Uses empathic and facilitating verbal behaviors such as: naming,
affirmation, normalization, reflection, silence, listening, self-disclosure,
and humor in an effective and appropriate manner.
o Demonstrates ability to recognize and respond to own emotions and
those of others.
o Expresses awareness of own emotional state before, during, and after
patient and family encounters.
o Self-corrects communication miscues.
o Processes own emotions in a clinical setting in order to focus on the
needs of the patient and family.
o Responds effectively to intense emotions of patients, families and
colleagues.
 Apply expertise in the ability to educate patients/families about the medical,
social and psychological issues associated with life-limiting illness.
 Apply expertise in the ability to effectively communicate with patients
regarding all aspects of their care including a new diagnosis, relapse or
transition to end-of-life care.
 Apply expertise in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians on the
UW Palliative Care Ward and Consult service.
 Apply expertise in the ability to manage areas of conflict and to negotiate
appropriate resolutions to these challenges.
 Apply expertise in the ability to give critical and praiseworthy feedback to
subordinate learners to help those learners along their paths.
40
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively in the
outpatient clinic with all members of the healthcare team, and fulfill stated
promises and obligations to patients and staff (OCRN, pharmacist,
scheduler, medical assistant, triage, and patients).
 Apply expertise to develop as a leader and a role-model for the learner
members of the treatment team (i.e., medical students and residents).
 Apply expertise in the ability to become an effective educator of learners
on the team.
 Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
 Apply expertise in the ability to achieve balance between the needs of
patients/family/team, while balancing one’s own need for self-care.
 Apply expertise in the ability show accountability to patients, society, and
the profession; and a commitment to excellence.
 Apply expertise in the ability to show respect and compassion towards all
patients and their families, as well as towards other clinicians.
Systems-Based Practice
The fellow will:
 Apply expertise in the ability to describe the various funding mechanisms for
hospice and palliative care and develop appropriate plans of care in this
context.
 Apply expertise in the ability to collaborate effectively with all the various
institutional providers of hospice and palliative care while advocating for
patients and families.
 Apply expertise in the ability to advocate for quality patient and family care,
and assists patients and families in dealing with system complexities.
 Apply expertise in the ability to work effectively on the UW Palliative Care
Ward and Consult service with all members of the healthcare team, and
fulfill stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Apply expertise in the ability to work effectively on the UW Palliative Care
Ward and Consult service with all members of the healthcare team in the
quality improvement of care in the outpatient setting. (E.g., participation on
the Chemotherapy Council).
 Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
 Apply expertise in the ability to effectively engage personnel and programs
(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.
41




Apply expertise in the ability to lead multidisciplinary health team rounds.
Apply expertise in teaching techniques and appreciation of educational
needs of residents by providing appropriate, level-specific didactics.
Apply expertise in the effective triage of night and weekend patient phone
calls that results in appropriate communication to involved parties and followup plans.
Apply expertise in the ability to identify when multispecialty consultation is
necessary and foster professional relationships with clinicians across a wide
variety of specialties.
MILESTONES BY YEAR OF TRAINING--Year 3.
General Overview:
 As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of inpatient and consultative care
of palliative care patients, relying on the attending for expertise and
guidance.
 In their third year in the Clinics:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology care. Attending MD’s will expect the fellows during this
year to present evidence-based care guidelines from the literature
and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
learn the art of designating responsibilities for patients’ care to the
various team members. They will be guided in this development by
the attending MD’s.
Core competencies:
Patient and Family Care
The fellow will:
42





Apply leadership and autonomy in gathering comprehensive and accurate
information from all pertinent sources, including patient, family members,
health care proxies, other health care providers, interdisciplinary team
members and medical records.
o Obtains a comprehensive medical history including:
 Patient understanding of illness and prognosis.
 Goals of care/advance care planning/proxy decision-making.
 Detailed symptom history.
 Psychosocial and coping history including loss history.
 Quality of life assessment.
 Depression evaluation (including stressors and areas of major
concern).
 Pharmacologic history including substance dependency or
abuse.
 Detailed neurological exam, including mental status exam.
Apply leadership and autonomy in the ability to synthesize and apply
information in the clinical setting by:
o Developing a prioritized differential diagnosis and problem list.
o Developing recommendations based on patient and family values.
Apply leadership and autonomy in the management physical symptoms,
psychological issues, social stressors, and spiritual dimensions of care for the
patient and family by:
o Assessing pain and non-pain symptoms.
o The use of opioid and non-opioid pharmacologic options.
o The use of non-pharmacologic symptom interventions.
o The management of neuropsychiatric disorders.
o The management of physical symptoms and psychosocial distress in
the patient and family.
o The re-assessment of symptoms frequently, and making of therapeutic
adjustments as needed.
Apply leadership and autonomy by demonstrating the use of the
interdisciplinary approach to develop a care plan that optimizes patient and
family goals and reduces suffering
Apply leadership and autonomy by the assessment of and communication of
prognosis.
Medical Knowledge
The fellow will:
 Apply leadership and autonomy in the ability to assess and communicate
prognosis:
o Identifies what elements of the patient’s history and physical
examination are critical to formulating prognosis for a given patient.
o Describes common chronic illnesses with prognostic factors, expected
natural course and trajectories, common treatments, and
complications.
o Describes effective strategies to communicate prognostic information
to patients, families, and health care providers.
43


o Recognize the presentation of common life-limiting illnesses,
syndromes, and their common complications.
Apply leadership and autonomy in the ability to describe pharmacologic
approaches to the management of common pain AND non-pain symptoms:
o Describes use of common agents used to treat dyspnea, nausea,
vomiting, diarrhea, constipation, anxiety, depression, fatigue, pruritus,
confusion, agitation, and other common problems in palliative care
practice
Apply leadership and autonomy in describing the ethical and legal issues in
palliative care and their clinical management
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Apply leadership and autonomy in actively engaging their attending MD’s
to verbalize their own unique learning needs in the pursuit of oncologic
learning specific to the patient profile to which they have been exposed.
 Apply leadership and autonomy in actively reviewing the electronic notes
the fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Apply leadership and autonomy in actively reflecting on their own clinical
practice in order to identify areas for improvement.
 Apply leadership and autonomy in critically appraising the literature for a
given solid tumor and to incorporate it into their practice and decisionmaking.
 Apply leadership and autonomy in actively describing, explaining and
clarifying a problem and identifying and incorporating new information in
order to better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply leadership and autonomy in the ability to initiate informed
relationship-centered dialogues about care:
o Assesses patient/family wishes regarding the amount of information
they wish to receive and the extent to which they want to participate in
clinical decision-making.
o Assesses patients’ and family members’ decision-making capacity,
and other strengths and limitations of understanding and
communication.
o Enlists legal surrogates to speak on behalf of a patient when making
decisions for a patient without decision-making capacity.
 Apply leadership and autonomy in the ability to demonstrates empathy:
o Uses empathic and facilitating verbal behaviors such as: naming,
affirmation, normalization, reflection, silence, listening, self-disclosure,
and humor in an effective and appropriate manner.
o Demonstrates ability to recognize and respond to own emotions and
those of others.
44





o Expresses awareness of own emotional state before, during, and after
patient and family encounters.
o Self-corrects communication miscues.
o Processes own emotions in a clinical setting in order to focus on the
needs of the patient and family.
o Responds effectively to intense emotions of patients, families and
colleagues.
Apply leadership and autonomy in the ability to educate patients/families
about the medical, social and psychological issues associated with lifelimiting illness.
Apply leadership and autonomy in the ability to effectively communicate
with patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
Apply leadership and autonomy in the maintenance of an appropriate level
of professionalism with the staff, midlevel providers and physicians on the
UW Palliative Care Ward and Consult service.
Apply leadership and autonomy in the ability to manage areas of conflict
and to negotiate appropriate resolutions to these challenges.
Apply leadership and autonomy in the ability to give critical and
praiseworthy feedback to subordinate learners to help those learners
along their paths.
Professionalism
The fellow will:
 Apply leadership and autonomy in the ability to work and communicate
effectively in the outpatient clinic with all members of the healthcare team,
and fulfill stated promises and obligations to patients and staff (OCRN,
pharmacist, scheduler, medical assistant, triage, and patients).
 Apply leadership and autonomy to develop as a leader and a role-model
for the learner members of the treatment team (i.e., medical students and
residents).
 Apply leadership and autonomy in the ability to become an effective
educator of learners on the team.
 Apply leadership and autonomy in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
 Apply leadership and autonomy in the ability to achieve balance between
the needs of patients/family/team, while balancing one’s own need for selfcare.
 Apply leadership and autonomy in the ability show accountability to
patients, society, and the profession; and a commitment to excellence.
 Apply leadership and autonomy in the ability to show respect and
compassion towards all patients and their families, as well as towards other
clinicians.
45
Systems-Based Practice
The fellow will:
 Apply leadership and autonomy in the ability to describe the various funding
mechanisms for hospice and palliative care and develop appropriate plans of
care in this context.
 Apply leadership and autonomy in the ability to collaborate effectively with
all the various institutional providers of hospice and palliative care while
advocating for patients and families.
 Apply leadership and autonomy in the ability to advocate for quality patient
and family care, and assists patients and families in dealing with system
complexities.
 Apply leadership and autonomy in the ability to work effectively on the UW
Palliative Care Ward and Consult service with all members of the
healthcare team, and fulfill stated promises and obligations to patients
(OCRN, pharmacist, scheduler, medical assistant, triage, patients).
 Apply leadership and autonomy in the ability to work effectively on the UW
Palliative Care Ward and Consult service with all members of the
healthcare team in the quality improvement of care in the outpatient
setting. (E.g., participation on the Chemotherapy Council).
 Apply leadership and autonomy in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Apply leadership and autonomy in the ability to effectively engage




personnel and programs (i.e., nursing, social work, physical therapy, home
health care, etc.) necessary to provide optimal patient care.
Apply leadership and autonomy in the ability to lead multidisciplinary health
team rounds.
Apply leadership and autonomy in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Apply leadership and autonomy in the effective triage of night and weekend
patient phone calls that results in appropriate communication to involved
parties and follow-up plans.
Apply leadership and autonomy in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
Contacts for this Rotation:
Clinic Director: Dan Mulkerin, MD. Phone: 265-8047 dm2@medicine.wisc.edu
B6/6 Director: Vicki Hubbard
Palliative care faculty: Dr. Jim Cleary, Dr. Toby Campbell, Dr. Justine Bruce, Dr. Matt LoConte,
Dr. Bernie Micke.
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
46
27 April 2012
UW Oncology Ward Service
Goals and Objectives
OVERVIEW:
The Medical Oncology service is clinically heterogeneous, demanding with respect
to complex medical issues resulting from advanced malignancy and also
communication as it relates to changing goals of therapy and shared decision
making. The patient care team includes one attending, one fellow, and a physician
assistant. The fellow’s role is to participate in the evaluation and diagnostic workup
of all patients admitted to the service. Also, the fellow will spend time with patients
discussing new findings, treatment plans and items that relate to the administration
of chemotherapy and redefining goals of treatment. Each day, there are
multidisciplinary rounds during which representatives from social work, nursing,
dietary, pharmacy and case management available for planning. The fellows will
usually participate in these planning meetings. All patients are discussed and
examined with the team on daily rounds. The work load can vary greatly during the
rotation and it is expected that the fellow will take the lead to negotiate the
distribution of specific ward responsibilities between the attending and PA (writing
notes, admitting patients, etc.).
GENERAL DESCRIPTION OF RESPONSIBILITIES:
The fellow is responsible for overall clinical supervision and management of all
inpatients for 6 of 7 days per week. For an average of one day per week, the fellow
will have a day out of the hospital, without call and will sign-out their pager to the
attending physician. While on service, the fellow is expected to see and know the
progress of all patients each day. In the morning, the fellow should receive sign-out
from the hospitalist for any new or urgent clinical issues. If there are urgent issues in
the morning, the care should be managed or delegated prior to leaving the ward for
didactic sessions. Usually, the fellow will round with the attending and PA each day.
After plans are made in rounds, the fellow is expected to provide oversight and
leadership in carrying out the plans and assuring effective communication between
the various parties involved with the care of the patient. While on the inpatient
service, the fellow should cancel any morning clinics, but the fellow will always
attend their continuity clinic or any clinic assignment at the VA. The attending
understands the need to cover the service during these times. The fellow should
arrange a review of the patients at the end of the day prior to the departure and signout any notable clinical changes to the hospitalist team that is covering during the
night.
The fellow should assure a dictated H&P is completed on every patient (this may be
delegated to the RNP, PA or other provider). The fellow is not necessarily
responsible for the daily note, but the responsible party should be negotiated
between the PA, the attending and fellow. As fellows become more experienced in
47
the operation of the clinical service, they are expected to assume a greater
leadership role on the team. An experienced fellow (second and third year) should
exhibit the competence and comfort level to function as a junior attending for the
majority of the clinical problems seen on the oncology service. An important
objective for the oncology service is for first year fellows to develop competence in
an organized approach to the diagnosis and treatment of complications from
oncologic diseases seen on the service. By the second year, the objective is for
fellows to show expertise in the same areas for the common clinical problems. By
the third year, the objective is for fellows to show leadership and autonomy in the
same areas for the common clinical problems.
All chemotherapy orders (“treatment plans” in EPIC) should be reviewed by the
fellow. After completing the fellow’s Chemotherapy Course and writing orders under
the supervision of the attending, the fellow will be expected to complete and submit
chemotherapy orders independently.
OVERALL GOALS FOR THE ROTATION:
Fellows are expected to achieve the milestones listed below and to show
continued growth during each year of training; expected milestones are
discussed in more detail in the following section and are broken down by year in
training.
 To become adept at:
o Forming an organized approach in the diagnosis.
o Interpretation of test results.
o Medical management of varied solid tumor diseases.
o Medical management in the complications of both progressive
disease and treatment-induced side effects.
 To become adept at the ability to integrate clinical, radiographic, and
laboratory data to generate a differential diagnosis for a patient with a
solid tumor.
 To become adept at the ability to use the accepted staging and
prognosticating tools available for solid tumor malignancies for
determining appropriate treatment.
 To become an effective communicator with patients and patients’ families
regarding important aspects of a solid tumor diagnosis not limited to:
o Discussing a new diagnosis.
o Delivery of “bad news.”
o Discussion of disease recurrence or progression.
o Discussion of transition to end-of-life care.
o To become adept at the ability to communicate in a respectful and
effective manner, the treatment options appropriate for the patient’s
unique circumstance.
48
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
Oncology patients to achieve competence in the inpatient setting.
 In their first year in the Clinics:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Oncology care. Attending MD’s will guide the
fellows during this year in the appropriate use of evidence-based
care guidelines and the literature in developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
expected to develop competence in the application of their
supervisory skills by involvement in and overseeing the education
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
Core competencies:
Patient Care
The fellow will:
 Learn competence in an organized approach in the medical management
of a variety of solid tumors.
 Learn competence in an ability to integrate lab clinical data, pathology
results, and radiographic data to accurately diagnose and evaluate
patients with a solid tumor malignancy.
 Learn competence in the prescription and administration of
chemotherapeutic agents.
49




Learn competence in recognizing and understanding the side effect
profiles of various chemotherapeutic agents.
Learn competence in the performance of appropriate oncology-based
procedures; e.g., intrathecal chemotherapy administration.
Learn competence in the ability to function as a member of a team to
provide appropriate support to patients with solid tumors.
Learn competence in the triage of night and weekend patient phone calls
providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
 Demonstrate competence in the ability to describe the basic principles of a
variety of oncologic neoplasms and learn to effectively use this knowledge
to come up with an evidence-based treatment plan, searching sources for
evidence to support the fellow’s decision.
 Demonstrate competence in the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies for determining
appropriate treatment.
 Demonstrate competence in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
 Demonstrate competence in the management of patients admitted with
complications of malignant disease and/or its treatment such as:
o Acute spinal cord compression.
o New central nervous system metastases.
o Intractable chemotherapy-induced nausea and vomiting.
o Neutropenic fever.
o Newly diagnosed aggressive malignancy.
o Obstructive complications of cancer.
o Complications of radiotherapy.
o Transitions from active antineoplastic therapy to supportive
care/hospice.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Actively engaging their attending MD’s to verbalize their own unique
learning needs in the pursuit of oncologic learning specific to the patient
profile to which they have been exposed.
 Actively reviewing the electronic notes the fellow has written with the
attending physician to ensure they are complete, accurate, and entail a
thorough plan of care.
50



Actively reflecting on their own clinical practice in order to identify areas
for improvement.
Critically appraising the literature for a given solid tumor and to incorporate
it into their practice and decision-making.
Actively describing, explaining and clarifying a problem and identifying and
incorporating new information in order to better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians on the
UW Oncology ward service.
 Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
 Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Demonstrate competence in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the first year will regularly be
observed and the encounter evaluated by the attending MD in
which the fellow obtains consent for treatment. After the
observation, the fellow should discuss with the attending the
encounter and any opportunities for improvement. These
encounters will be evaluated at the end of a 6 month period.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively in the outpatient clinic with all members of the healthcare team,
and fulfill stated promises and obligations to patients and staff (OCRN,
pharmacist, scheduler, medical assistant, triage, and patients).
 Demonstrate the ability to develop as a leader and a role-model for the
learner members of the treatment team (i.e., medical students and
residents).
 Demonstrate competence in the ability to become an effective educator of
learners on the team.
51

Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Demonstrate competence in the prescription and administration of
chemotherapeutic agents.
 Demonstrate competence in the ability to work effectively on the UW
Oncology Ward service with all members of the healthcare team, and fulfill
stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Demonstrate competence in the ability to work effectively on the UW
Oncology Ward service with all members of the healthcare team in the
quality improvement of care in the outpatient setting. (E.g., participation on
the Chemotherapy Council).
 Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Demonstrate competence in the ability to effectively engage personnel




and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.
Demonstrate competence in the ability to lead multidisciplinary health team
rounds.
Demonstrate competence in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Demonstrate competence in the effective triage of night and weekend patient
phone calls that results in appropriate communication to involved parties and
follow-up plans.
Demonstrate competence in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
MILESTONES BY YEAR OF TRAINING--Year 2.
General Overview:
 As a second year learner, the fellow will work on applying the
fundamentals of inpatient care of Oncology patients.
 In their second year in the Clinics:
o Conditional Independence: Fellows are expected to be learning
more independence in their care of patients in their second year,
but still under the supervision of their attending MD’s. During this
year that they are applying the skills learned in their first year
52
towards more advanced Oncology care. Attending MD’s will expect
the fellows during this year to present evidence-based care
guidelines from the literature before developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will begin to have a more direct
supervisory role in their second year. They are expected to begin to
apply their supervisory skills and direct the education of residents
and medical students on the service. They will be expected to help
residents learn the methods best suited for evidence based care
and learning which they themselves learned in their first year of
fellowship. They will be guided in this development by the attending
MD’s.
Core competencies:
Patient Care
The fellow will be able to:
 Apply expertise to an organized approach in the medical management of a
variety of solid tumors.
 Apply expertise to an ability to integrate lab clinical data, pathology results,
and radiographic data to accurately diagnose and evaluate patients with a
solid tumor malignancy.
 Apply expertise to competence in the prescription and administration of
chemotherapeutic agents.
 Apply expertise to competence in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply expertise to competence in the performance of appropriate
oncology based procedures; e.g., intrathecal chemotherapy
administration.
 Apply expertise to the ability to function as a member of a team to provide
appropriate support to patients with solid tumors.
 Apply expertise in the triage of night and weekend patient phone calls
providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
 Apply expertise to describe the basic principles of a variety of oncologic
neoplasms and learn to effectively use this knowledge to come up with an
evidence-based treatment plan, searching sources for evidence to support
the fellow’s decision.
53

Apply expertise to the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies for determining
appropriate treatment.
 Apply expertise in the management of patients admitted with complications of
malignant disease and/or its treatment.
o Acute spinal cord compression.
o New central nervous system metastases.
o Intractable chemotherapy-induced nausea and vomiting.
o Neutropenic fever.
o Newly diagnosed aggressive malignancy.
o Obstructive complications of cancer.
o Complications of radiotherapy.
o Transitions from active antineoplastic therapy to supportive
care/hospice.
 Apply expertise to the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will:
 Apply expertise to actively engage their attending MD’s to verbalize their
own unique learning needs in the pursuit of oncologic learning specific to
the patient profile to which they have been exposed.
 Apply expertise to review the electronic notes the fellow has written with
the attending physician to ensure they are complete, accurate, and entail
a thorough plan of care.
 Apply expertise to demonstrate the ability to reflect on their own clinical
practice in order to identify areas for improvement.
 Apply expertise to demonstrate the capability to critically appraise the
literature for a given solid tumor and to incorporate it into their practice and
decision-making.
 Apply expertise to demonstrate the ability to describe, explain and clarify a
problem and to identify and incorporate new information to optimize
patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply expertise to demonstrate the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Apply expertise to demonstrate the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
54




Apply expertise to maintain an appropriate level of professionalism with
the staff, midlevel providers and physicians in the UW Oncology Ward
service.
Apply expertise to demonstrate the ability to manage areas of conflict and
to negotiate appropriate resolutions to these challenges.
Apply expertise to demonstrate the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
Apply expertise to satisfactorily discuss a chemotherapy treatment plan
with a patient incorporating the process of informed consent.
o It is expected that fellows during the second year will be competent
to obtain consent for treatment for their patient population. The
fellow will continue to discuss the encounter with the attending and
any opportunities for improvement.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively on the
UW Oncology Ward service with all members of the healthcare team, and
fulfill stated promises and obligations to patients and staff (OCRN,
pharmacist, scheduler, medical assistant, triage, and patients).
 Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
 Apply expertise in the ability to become an effective educator of learners
on the team.
 Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
Systems-Based Practice
The fellow will:
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in the ability to work effectively on the UW Oncology Ward
service with all members of the healthcare team, and fulfill stated
promises and obligations to patients (OCRN, pharmacist, scheduler,
medical assistant, triage, patients).
 Apply expertise in the ability to work effectively on the UW Oncology Ward
service with all members of the healthcare team in the quality
improvement of care in the outpatient setting. (E.g., participation on the
Chemotherapy Council).
 Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
55
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
 Apply expertise in the ability to effectively engage personnel and programs




(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.
Apply expertise in the ability to lead multidisciplinary health team rounds.
Apply expertise in teaching techniques and appreciation of educational
needs of residents by providing appropriate, level-specific didactics.
Apply expertise in the effective triage of night and weekend patient phone
calls that results in appropriate communication to involved parties and followup plans.
Apply expertise in the ability to identify when multispecialty consultation is
necessary and foster professional relationships with clinicians across a wide
variety of specialties.
MILESTONES BY YEAR OF TRAINING--Year 3.
General Overview:
 As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of inpatient care of Oncology
patients, relying on the attending for expertise and guidance.
 In their third year in the Clinics:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology care. Attending MD’s will expect the fellows during this
year to present evidence-based care guidelines from the literature
and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
learn the art of designating responsibilities for patients’ care to the
various team members. They will be guided in this development by
the attending MD’s.
56
Core competencies:
Patient Care
The fellow will be able to:
 Apply leadership and autonomy to an organized approach in the medical
management of a variety of solid tumors.
 Apply leadership and autonomy to an ability to integrate lab clinical data,
pathology results, and radiographic data to accurately diagnose and
evaluate patients with a solid tumor malignancy.
 Apply leadership and autonomy to competence in the prescription and
administration of chemotherapeutic agents.
 Apply leadership and autonomy in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply leadership and autonomy in the performance of appropriate
oncology based procedures; e.g., intrathecal chemotherapy
administration.
 Apply leadership and autonomy in the ability to function as a member of a
team to provide appropriate support to patients with solid tumors.
 Apply leadership and autonomy in the triage of night and weekend patient
phone calls providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
 Apply leadership and autonomy to describe the basic principles of a
variety of oncologic neoplasms and learn to effectively use this knowledge
to come up with an evidence-based treatment plan, searching sources for
evidence to support the fellow’s decision.
 Apply leadership and autonomy to the ability to use the accepted staging
and prognosticating tools available for oncologic malignancies for
determining appropriate treatment.
 Apply leadership and autonomy in the management of patients admitted with
complications of malignant disease and/or its treatment.
o Acute spinal cord compression.
o New central nervous system metastases.
o Intractable chemotherapy-induced nausea and vomiting.
o Neutropenic fever.
o Newly diagnosed aggressive malignancy.
o Obstructive complications of cancer.
o Complications of radiotherapy.
o Transitions from active antineoplastic therapy to supportive
care/hospice.
 Apply expertise to the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
57

Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.

Practice-Based Learning and Improvement
The fellow will:
 Apply leadership and autonomy to actively engage their attending MD’s to
verbalize their own unique learning needs in the pursuit of oncologic
learning specific to the patient profile to which they have been exposed.
 Apply leadership and autonomy in the review of the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Apply leadership and autonomy to demonstrate the ability to reflect on
their own clinical practice in order to identify areas for improvement.
 Apply leadership and autonomy to demonstrate the capability to critically
appraise the literature for a given solid tumor and to incorporate it into
their practice and decision-making.
 Apply leadership and autonomy to demonstrate the ability to describe,
explain and clarify a problem and to identify and incorporate new
information to optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply leadership and autonomy to demonstrate the ability to interact in an
appropriate therapeutic relationship with patients and families.
 Apply leadership and autonomy to demonstrate the ability to effectively
communicate with patients regarding all aspects of their care including a
new diagnosis, relapse or transition to end-of-life care.
 Apply leadership and autonomy to maintain an appropriate level of
professionalism with the staff, midlevel providers and physicians on the
UW Oncology Ward service.
 Apply leadership and autonomy to demonstrate the ability to manage
areas of conflict and to negotiate appropriate resolutions to these
challenges.
 Apply leadership and autonomy to demonstrate the ability to give critical
and praiseworthy feedback to subordinate learners to help those learners
along their paths.
 Apply leadership and autonomy to satisfactorily discuss a chemotherapy
treatment plan with a patient incorporating the process of informed
consent.
o It is expected that fellows during the third year will be independent
and will apply autonomous leadership to obtain consent for
treatment for their patient population. The fellow will continue to
utilize the attending MD for guidance and support.
58
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply leadership and autonomy in the ability to work and communicate
effectively on the UW Oncology Ward service with all members of the
healthcare team, and fulfill stated promises and obligations to patients and
staff (OCRN, pharmacist, scheduler, medical assistant, triage, and
patients).
 Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
 Apply leadership and autonomy in the ability to become an effective
educator of learners on the team.
 Apply leadership and autonomy in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
 Apply leadership and autonomy in the ability to work effectively on the UW
Oncology Ward service with all members of the healthcare team, and fulfill
stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Apply leadership and autonomy in the ability to work effectively on the UW
Oncology Ward service with all members of the healthcare team in the
quality improvement of care in the outpatient setting. (E.g., participation on
the Chemotherapy Council).
 Apply leadership and autonomy in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Apply leadership and autonomy in the ability to effectively engage



personnel and programs (i.e., nursing, social work, physical therapy, home
health care, etc.) necessary to provide optimal patient care.
Apply leadership and autonomy in the ability to lead multidisciplinary health
team rounds.
Apply leadership and autonomy in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Apply leadership and autonomy in the effective triage of night and weekend
patient phone calls that results in appropriate communication to involved
parties and follow-up plans.
59

Apply leadership and autonomy in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
Contacts for this Rotation:
Clinic Director: Dan Mulkerin, MD. Phone: 265-8047 dm2@medicine.wisc.edu
B6/6 Director: Vicki Hubbard
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
60
27 April 2012
UW Inpatient Oncology Consult Service
Goals and Objectives
OVERVIEW:
The overall goal of this rotation is for the fellow to develop the skills necessary for
effective consultation for hospitalized patients with malignant solid tumors. The
majority of the requests pertain to patients who have a recent diagnosis of cancer
and have yet to meet an oncologist. Other typical consults are patients with a
diagnosis of cancer who are admitted to other services and there is a particular
oncologic question.
GENERAL DESCRIPTION OF RESPONSIBILITIES:
The fellow is expected to assume a leadership role in managing the work-flow on the
service that covers both the VA and UW. Consults will be reported to the fellow
primarily and the fellow is responsible for triaging consults as they are received and
managing the work load with the attending and resident on service. The fellow is
responsible for ensuring that all consults are seen and staffed with 24 hours. The
fellow will monitor the active patient list and will ensure that follow-up, if needed is
carried through until sign-off or discharge. If outpatient oncology follow-up is needed,
the fellow will assure appropriate plans are scheduled and the plans communicated
to the referring physician and patient. The fellow may choose to transfer a patient to
the inpatient UW medical oncology service if the primary problem is perceived to be
oncologic and ongoing inpatient oncologic care is needed. This should be discussed
with the inpatient attending physician prior to any transfer of service. We expect the
fellow to assure that verbal contact is made with the primary team after consultation
to assure adequate communication of the recommendations.
The fellow is responsible for triaging outpatient VA oncology consult requests and
handles the inpatient consults at the VA. The fellow has no call responsibilities from
the VA. Occasionally, the consult fellow may be called upon to help out in the VA
oncology clinics for vacations, sickness, etc. Fellows take beeper call while on the
oncology ward and consult clinical services. There is backup provided by an
attending. Typically, the ward fellow alternates weeks of call with the consult fellow.
The calls are primarily from patients followed in oncology clinic, referrals from
outside physicians, and questions from house staff concerning inpatients. Problems
and admissions involving oncology ward patients should be communicated promptly
to the ward fellow. All admits are to be discussed with the oncology fellow. This
could be through direct calls to the oncology ward fellow from house staff or from the
consult fellow on call.
OVERALL GOALS FOR THE ROTATION:
Fellows are expected to achieve the milestones listed below and to show
continued growth during each year of training; expected milestones are
61
discussed in more detail in the following section and are broken down by year in
training.
 To become proficient in the inpatient evaluation of patients with malignant
solid tumors.
 To become proficient in the inpatient evaluation of patients with malignant
solid tumors and the consultative management of complications of both
oncologic diseases and oncologic treatments.
 To become an effective consultant in the discipline of medical oncology.
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
Oncology patients to achieve competence in the outpatient setting.
 In their first year in the Clinics:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Oncology care. Attending MD’s will guide the
fellows during this year in the appropriate use of evidence-based
care guidelines and the literature in developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
expected to develop competence in the application of their
supervisory skills by involvement in and overseeing the education
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
Core competencies:
Patient Care
62
The fellow will:
 Learn competence in an organized approach in the medical management
of a variety of solid tumors.
 Learn competence in an ability to integrate lab clinical data, pathology
results, and radiographic data to accurately diagnose and evaluate
patients with a solid tumor malignancy.
 Learn competence in the prescription and administration of
chemotherapeutic agents.
 Learn competence in recognizing and understanding the side effect
profiles of various chemotherapeutic agents.
 Learn competence in the performance of appropriate oncology-based
procedures; e.g., intrathecal chemotherapy administration.
 Learn competence in the ability to function as a member of a team to
provide appropriate support to patients with solid tumors and to the team
who has asked for the consultation.
Medical Knowledge
The fellow will:
 Demonstrate competence in the ability to describe the basic principles of a
variety of oncologic neoplasms and learn to effectively use this knowledge
to come up with an evidence-based treatment plan, searching sources for
evidence to support the fellow’s decision.
 Demonstrate competence in the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies for determining
appropriate treatment.
 Demonstrate competence in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by the ability to:
 Demonstrate competence by actively engaging their attending MD’s to
verbalize their own unique learning needs in the pursuit of oncologic
learning specific to the patient profile to which they have been exposed.
 Demonstrate competence by actively reviewing the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Demonstrate competence by actively reflecting on their own clinical
practice in order to identify areas for improvement.
 Demonstrate competence by critically appraising the literature for a given
solid tumor and to incorporate it into their practice and decision-making.
63

Demonstrate competence by actively describing, explaining and clarifying
a problem and identifying and incorporating new information in order to
better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
UW Inpatient Oncology Consult service.
 Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
 Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Demonstrate competence in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the first year will regularly be
observed and the encounter evaluated by the attending MD in
which the fellow obtains consent for treatment. After the
observation, the fellow should discuss with the attending the
encounter and any opportunities for improvement. These
encounters will be evaluated at the end of a 6 month period.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively on the UW Inpatient Oncology Consult service with all members
of the healthcare team, and fulfill stated promises and obligations to
patients and staff (OCRN, pharmacist, scheduler, medical assistant,
triage, and patients).
 Demonstrate the ability to develop as a leader and a role-model for the
learner members of the treatment team (i.e., medical students and
residents).
 Demonstrate competence in the ability to become an effective educator of
learners on the team.
 Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
64
Systems-Based Practice
The fellow will:
 Demonstrate competence in the prescription and administration of
chemotherapeutic agents.
 Demonstrate competence in the ability to work effectively on the UW
Inpatient Oncology Consult service with all members of the healthcare
team, and fulfill stated promises and obligations to patients (OCRN,
pharmacist, scheduler, medical assistant, triage, patients).
 Demonstrate competence in the ability to work effectively on the UW
Inpatient Oncology Consult service with all members of the healthcare
team in the quality improvement of care in the outpatient setting. (E.g.,
participation on the Chemotherapy Council).
 Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Demonstrate competence in the ability to effectively engage personnel
and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.

Demonstrate competence in the ability to effectively triage after-hours calls
and “curbside” consults (these calls should all be reviewed with the attending
during the first month of service).
MILESTONES BY YEAR OF TRAINING--Year 2.
General Overview:
 As a second year learner, the fellow will work on applying the
fundamentals of outpatient care of Oncology patients.
 In their second year in the Clinics:
o Conditional Independence: Fellows are expected to be learning
more independence in their care of patients in their second year,
but still under the supervision of their attending MD’s. During this
year that they are applying the skills learned in their first year
towards more advanced Oncology care. Attending MD’s will expect
the fellows during this year to present evidence-based care
guidelines from the literature before developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will begin to have a more direct
supervisory role in their second year. They are expected to begin to
65
apply their supervisory skills and direct the education of residents
and medical students on the service. They will be expected to help
residents learn the methods best suited for evidence based care
and learning which they themselves learned in their first year of
fellowship. They will be guided in this development by the attending
MD’s.
Core competencies:
Patient Care
The fellow will:
 Apply expertise in an organized approach in the medical management of a
variety of solid tumors.
 Apply expertise in an ability to integrate lab clinical data, pathology results,
and radiographic data to accurately diagnose and evaluate patients with a
solid tumor malignancy.
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in recognizing and understanding the side effect profiles of
various chemotherapeutic agents.
 Apply expertise in the performance of appropriate oncology-based
procedures; e.g., intrathecal chemotherapy administration.
 Apply expertise in the ability to function as a member of a team to provide
appropriate support to patients with solid tumors and to the team who has
asked for the consultation.
Medical Knowledge
The fellow will:
 Apply expertise in the ability to describe the basic principles of a variety of
oncologic neoplasms and learn to effectively use this knowledge to come
up with an evidence-based treatment plan, searching sources for evidence
to support the fellow’s decision.
 Apply expertise in the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies for determining
appropriate treatment.
 Apply expertise in the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by the ability to:
66





Apply expertise by actively engaging their attending MD’s to verbalize their
own unique learning needs in the pursuit of oncologic learning specific to
the patient profile to which they have been exposed.
Apply expertise by actively reviewing the electronic notes the fellow has
written with the attending physician to ensure they are complete, accurate,
and entail a thorough plan of care.
Apply expertise by actively reflecting on their own clinical practice in order
to identify areas for improvement.
Apply expertise by critically appraising the literature for a given solid tumor
and to incorporate it into their practice and decision-making.
Apply expertise by actively describing, explaining and clarifying a problem
and identifying and incorporating new information in order to better
optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply expertise in the ability to interact in an appropriate therapeutic
relationship with patients and families.
 Apply expertise in the ability to effectively communicate with patients
regarding all aspects of their care including a new diagnosis, relapse or
transition to end-of-life care.
 Apply expertise in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
UW Inpatient Oncology Consult service.
 Apply expertise in the ability to manage areas of conflict and to negotiate
appropriate resolutions to these challenges.
 Apply expertise in the ability to give critical and praiseworthy feedback to
subordinate learners to help those learners along their paths.
 Apply expertise in the ability to satisfactorily discuss a chemotherapy
treatment plan with a patient incorporating the process of informed
consent.
o It is expected that fellows during the second year will be competent
to obtain consent for treatment for their patient population. The
fellow will continue to discuss the encounter with the attending and
any opportunities for improvement.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively on the
UW Inpatient Oncology Consult service with all members of the healthcare
team, and fulfill stated promises and obligations to patients and staff
(OCRN, pharmacist, scheduler, medical assistant, triage, and patients).
67



Apply expertise to develop as a leader and a role-model for the learner
members of the treatment team (i.e., medical students and residents).
Apply expertise in the ability to become an effective educator of learners
on the team.
Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
Systems-Based Practice
The fellow will:
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in the ability to work effectively on the UW Inpatient
Oncology Consult service with all members of the healthcare team, and
fulfill stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Apply expertise in the ability to work effectively on the UW Inpatient
Oncology Consult service with all members of the healthcare team in the
quality improvement of care in the outpatient setting. (E.g., participation on
the Chemotherapy Council).
 Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
 Apply expertise in the ability to effectively engage personnel and programs
(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.

Apply expertise in the ability to effectively triage after-hours calls and
“curbside” consults (these calls should all be reviewed with the attending
during the first month of service).
MILESTONES BY YEAR OF TRAINING--Year 3.
General Overview:
 As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of outpatient care of Oncology
patients, relying on the attending for expertise and guidance.
 In their third year in the Clinics:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology care. Attending MD’s will expect the fellows during this
68
year to present evidence-based care guidelines from the literature
and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
learn the art of designating responsibilities for patients’ care to the
various team members. They will be guided in this development by
the attending MD’s.
Core competencies:
Patient Care
The fellow will:
 Apply expertise in an organized approach in the medical management of a
variety of solid tumors.
 Apply expertise in an ability to integrate lab clinical data, pathology results,
and radiographic data to accurately diagnose and evaluate patients with a
solid tumor malignancy.
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in recognizing and understanding the side effect profiles of
various chemotherapeutic agents.
 Apply expertise in the performance of appropriate oncology-based
procedures; e.g., intrathecal chemotherapy administration.
 Apply expertise in the ability to function as a member of a team to provide
appropriate support to patients with solid tumors and to the team who has
asked for the consultation.
Medical Knowledge
The fellow will:
 Apply expertise in the ability to describe the basic principles of a variety of
oncologic neoplasms and learn to effectively use this knowledge to come
up with an evidence-based treatment plan, searching sources for evidence
to support the fellow’s decision.
69



Apply expertise in the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies for determining
appropriate treatment.
Apply expertise in the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by the ability to:
 Apply expertise by actively engaging their attending MD’s to verbalize their
own unique learning needs in the pursuit of oncologic learning specific to
the patient profile to which they have been exposed.
 Apply expertise by actively reviewing the electronic notes the fellow has
written with the attending physician to ensure they are complete, accurate,
and entail a thorough plan of care.
 Apply expertise by actively reflecting on their own clinical practice in order
to identify areas for improvement.
 Apply expertise by critically appraising the literature for a given solid tumor
and to incorporate it into their practice and decision-making.
 Apply expertise by actively describing, explaining and clarifying a problem
and identifying and incorporating new information in order to better
optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply expertise in the ability to interact in an appropriate therapeutic
relationship with patients and families.
 Apply expertise in the ability to effectively communicate with patients
regarding all aspects of their care including a new diagnosis, relapse or
transition to end-of-life care.
 Apply expertise in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
UW Inpatient Oncology Consult service.
 Apply expertise in the ability to manage areas of conflict and to negotiate
appropriate resolutions to these challenges.
 Apply expertise in the ability to give critical and praiseworthy feedback to
subordinate learners to help those learners along their paths.
 Apply expertise in the ability to satisfactorily discuss a chemotherapy
treatment plan with a patient incorporating the process of informed
consent.
70
o It is expected that fellows during the third year will be independent
and will apply autonomous leadership to obtain consent for
treatment for their patient population. The fellow will continue to
utilize the attending MD for guidance and support.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively on the
UW Inpatient Oncology Consult service with all members of the healthcare
team, and fulfill stated promises and obligations to patients and staff
(OCRN, pharmacist, scheduler, medical assistant, triage, and patients).
 Apply expertise to develop as a leader and a role-model for the learner
members of the treatment team (i.e., medical students and residents).
 Apply expertise in the ability to become an effective educator of learners
on the team.
 Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
Systems-Based Practice
The fellow will:
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in the ability to work effectively on the UW Inpatient
Oncology Consult service with all members of the healthcare team, and
fulfill stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Apply expertise in the ability to work effectively on the UW Inpatient
Oncology Consult service with all members of the healthcare team in the
quality improvement of care in the outpatient setting. (E.g., participation on
the Chemotherapy Council).
 Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
 Apply expertise in the ability to effectively engage personnel and programs
(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.

Apply expertise in the ability to effectively triage after-hours calls and
“curbside” consults (these calls should all be reviewed with the attending
during the first month of service).
Contacts for this Rotation:
71
**See the faculty consult schedule to determine the appropriate faculty member to contact prior to
the beginning of your rotation.**
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
72
20 April 2012
UW Oncology Clinic
Goals and Objectives
OVERVIEW:
The UW Oncology faculty all have outpatient clinics that care for patients with a
variety of solid tumors. The clinics are usually organized around an attending MD
with a particular disease focus, a nurse that is usually familiar with the patients
seen in the clinic, a medical assistant and sometimes a nurse practitioner. There
is a “triage” service operated by a rotating group of RN’s and MA’s that will field
outside calls regarding laboratory values, follow-up schedules, medication refills
and general questions. Calls pertaining to new health issues will be forwarded to
the physician or fellow responsible for the patient when clinically indicated in the
judgment of the RN.
DEFINITIONS:
Continuity clinics:
The fellows will participate in one half-day clinic per week during their 3-year
training program that will include either oncology or hematology disciplines. This
clinic will exist in solid 6-month blocks and is deemed the “continuity” clinic. The
fellow will attend every week regardless of the other assignments and will have
no excused absences due to ward responsibilities. The continuity clinic may be a
UW or VA clinic and will preferentially be scheduled in the afternoon to avoid
conflict with rounding times on the inpatient service. In this clinic, the fellow must
accrue a group of patients that can be identified by the continuity with which the
patients return to see the fellow. If the fellow perceives that patients are not
returning to their schedule, they should discuss this with the attending or program
director. These clinics serve to provide the fellows with a cadre of regular
patients with regular follow up to help them learn the “ins-and-outs” of solid tumor
patient care, communication and the delivery of health care within various
systems at the UW.
Non-Continuity Clinics:
The fellows will participate in 1 to 4 half-day clinics per week that will include
oncology or hematology disciplines, depending on their year in training. These
clinics will exist in 4-month blocks and are deemed the “non-continuity” clinics.
The fellow will attend every week, but will be excused from these clinics for
competing ward responsibilities. The non-continuity clinic may be a UW or VA
clinic and will preferentially be scheduled in the afternoon to avoid conflict with
rounding times on the inpatient service. While the fellows may establish a cadre
of regular follow-up patients during these blocks that is not the focus of these
clinics. These clinics serve to further the exposure to different types of solid
tumors based on organ system.
73
GENERAL DESCRIPTION OF RESPONSIBILITIES:
Each fellow will be assigned to an attending physician’s clinic and all patient
visits to the fellow in clinic will be staffed by that physician. The attending
physicians have clinics organized by their own clinical and research interests. A
fellow will find the experiences in different clinics to vary greatly with respect to
the types of diagnoses seen. For this reason, all fellows will be rotated through
different UW faculty member clinics during their fellowship.
The fellow should assume primary responsibility for all patients they see in their
clinic. In addition to patient encounters, the duties include: dictating all physician
visits, writing chemotherapy orders, calling patients with lab results, following up
on diagnostic tests, discussing issues with family, etc. Essentially, the fellow
should assume all responsibilities required to effectively care for the outpatient
and facilitate transitions between inpatient and outpatient care. Each patient visit
should be staffed by the attending physician. The attending should see all
patients in clinic as they are ultimately responsible for their care. All dictations
need to be co-signed by the attending. The charge codes are required to be
completed by the attending, but the fellow should discuss the various charges
and should be aware of the connection between the service provided and the
charges applied.
OVERALL GOALS FOR THE ROTATION:
Fellows are expected to achieve the milestones listed below and to show
continued growth during each year of training; expected milestones are
discussed in more detail in the following section and are broken down by year in
training.
 To become adept at:
o Forming an organized approach in the diagnosis.
o Interpretation of test results.
o Medical management of varied solid tumor diseases.
 To become adept at the ability to integrate clinical, radiographic, and
laboratory data to generate a differential diagnosis for a patient with a
solid tumor.
 To become adept at the ability to use the accepted staging and
prognosticating tools available for solid tumor malignancies for
determining appropriate treatment.
 To become an effective communicator with patients and patients’ families
regarding important aspects of a solid tumor diagnosis not limited to:
o Discussing a new diagnosis.
o Delivery of “bad news.”
o Discussion of disease recurrence or progression.
o Discussion of transition to end-of-life care.
74
o
To become adept at the ability to communicate in a respectful and
effective manner, the treatment options appropriate for the patient’s
unique circumstance.
o
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
Oncology patients to achieve competence in the outpatient setting.
 In their first year in the Clinics:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Oncology care. Attending MD’s will guide the
fellows during this year in the appropriate use of evidence-based
care guidelines and the literature in developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
expected to develop competence in the application of their
supervisory skills by involvement in and overseeing the education
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
Core competencies:
Patient Care
The fellow will:
 Learn competence in an organized approach in the medical management
of a variety of solid tumors.
75





Learn competence in an ability to integrate lab clinical data, pathology
results, and radiographic data to accurately diagnose and evaluate
patients with a solid tumor malignancy.
Learn competence in the prescription and administration of
chemotherapeutic agents.
Learn competence in recognizing and understanding the side effect
profiles of various chemotherapeutic agents.
Learn competence in the performance of appropriate oncology-based
procedures; e.g., intrathecal chemotherapy administration.
Learn competence in the ability to function as a member of a team to
provide appropriate support to patients with solid tumors.
Medical Knowledge
The fellow will:
 Demonstrate competence in the ability to describe the basic principles of a
variety of oncologic neoplasms and learn to effectively use this knowledge
to come up with an evidence-based treatment plan, searching sources for
evidence to support the fellow’s decision.
 Demonstrate competence in the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies for determining
appropriate treatment.
 Demonstrate competence in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Demonstrate competence by actively engaging their attending MD’s to
verbalize their own unique learning needs in the pursuit of oncologic
learning specific to the patient profile to which they have been exposed.
 Demonstrate competence by actively reviewing the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Demonstrate competence by actively reflecting on their own clinical
practice in order to identify areas for improvement.
 Demonstrate competence by critically appraising the literature for a given
solid tumor and to incorporate it into their practice and decision-making.
 Demonstrate competence by actively describing, explaining and clarifying
a problem and identifying and incorporating new information in order to
better optimize patient care.
76
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
UW oncology clinic.
 Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
 Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Demonstrate competence in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the first year will regularly be
observed and the encounter evaluated by the attending MD in
which the fellow obtains consent for treatment. After the
observation, the fellow should discuss with the attending the
encounter and any opportunities for improvement. These
encounters will be evaluated at the end of a 6 month period.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively in the outpatient clinic with all members of the healthcare team,
and fulfill stated promises and obligations to patients and staff (OCRN,
pharmacist, scheduler, medical assistant, triage, and patients).
 Demonstrate the ability to develop as a leader and a role-model for the
learner members of the treatment team (i.e., medical students and
residents).
 Demonstrate competence in the ability to become an effective educator of
learners on the team.
 Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Demonstrate competence in the prescription and administration of
chemotherapeutic agents.
77




Demonstrate competence in the ability to work effectively in the outpatient
clinic with all members of the healthcare team, and fulfill stated promises
and obligations to patients (OCRN, pharmacist, scheduler, medical
assistant, triage, patients).
Demonstrate competence in the ability to work effectively in the outpatient
clinic with all members of the healthcare team in the quality improvement
of care in the outpatient setting. (E.g., participation on the Chemotherapy
Council).
Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
Demonstrate competence in the ability to effectively engage personnel
and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.
MILESTONES BY YEAR OF TRAINING--Year 2.
General Overview:
 As a second year learner, the fellow will work on applying the
fundamentals of outpatient care of Oncology patients.
 In their second year in the Clinics:
o Conditional Independence: Fellows are expected to be learning
more independence in their care of patients in their second year,
but still under the supervision of their attending MD’s. During this
year that they are applying the skills learned in their first year
towards more advanced Oncology care. Attending MD’s will expect
the fellows during this year to present evidence-based care
guidelines from the literature before developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will begin to have a more direct
supervisory role in their second year. They are expected to begin to
apply their supervisory skills and direct the education of residents
and medical students on the service. They will be expected to help
residents learn the methods best suited for evidence based care
and learning which they themselves learned in their first year of
fellowship. They will be guided in this development by the attending
MD’s.
Core competencies:
Patient Care
78
The fellow will be able to:
 Apply expertise to an organized approach in the medical management of a
variety of solid tumors.
 Apply expertise to an ability to integrate lab clinical data, pathology results,
and radiographic data to accurately diagnose and evaluate patients with a
solid tumor malignancy.
 Apply expertise to competence in the prescription and administration of
chemotherapeutic agents.
 Apply expertise to competence in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply expertise to competence in the performance of appropriate
oncology based procedures; e.g., intrathecal chemotherapy
administration.
 Apply expertise to the ability to function as a member of a team to provide
appropriate support to patients with solid tumors.
Medical Knowledge
The fellow will:
 Apply expertise to describe the basic principles of a variety of oncologic
neoplasms and learn to effectively use this knowledge to come up with an
evidence-based treatment plan, searching sources for evidence to support
the fellow’s decision.
 Apply expertise to the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies for determining
appropriate treatment.
 Apply expertise to the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will:
 Apply expertise to actively engage their attending MD’s to verbalize their
own unique learning needs in the pursuit of oncologic learning specific to
the patient profile to which they have been exposed.
 Apply expertise to review the electronic notes the fellow has written with
the attending physician to ensure they are complete, accurate, and entail
a thorough plan of care.
 Apply expertise to demonstrate the ability to reflect on their own clinical
practice in order to identify areas for improvement.
79


Apply expertise to demonstrate the capability to critically appraise the
literature for a given solid tumor and to incorporate it into their practice and
decision-making.
Apply expertise to demonstrate the ability to describe, explain and clarify a
problem and to identify and incorporate new information to optimize
patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply expertise to demonstrate the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Apply expertise to demonstrate the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Apply expertise to maintain an appropriate level of professionalism with
the staff, midlevel providers and physicians in the UW oncology clinic.
 Apply expertise to demonstrate the ability to manage areas of conflict and
to negotiate appropriate resolutions to these challenges.
 Apply expertise to demonstrate the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Apply expertise to satisfactorily discuss a chemotherapy treatment plan
with a patient incorporating the process of informed consent.
o It is expected that fellows during the second year will be competent
to obtain consent for treatment for their patient population. The
fellow will continue to discuss the encounter with the attending and
any opportunities for improvement.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively in the
outpatient clinic with all members of the healthcare team, and fulfill stated
promises and obligations to patients and staff (OCRN, pharmacist,
scheduler, medical assistant, triage, and patients).
 Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
 Apply expertise in the ability to become an effective educator of learners
on the team.
 Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
Systems-Based Practice
The fellow will:
80





Apply expertise in the prescription and administration of chemotherapeutic
agents.
Apply expertise in the ability to work effectively in the outpatient clinic with
all members of the healthcare team, and fulfill stated promises and
obligations to patients (OCRN, pharmacist, scheduler, medical assistant,
triage, patients).
Apply expertise in the ability to work effectively in the outpatient clinic with
all members of the healthcare team in the quality improvement of care in
the outpatient setting. (E.g., participation on the Chemotherapy Council).
Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
Apply expertise in the ability to effectively engage personnel and programs
(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.
MILESTONES BY YEAR OF TRAINING--Year 3.
General Overview:
 As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of outpatient care of Oncology
patients, relying on the attending for expertise and guidance.
 In their third year in the Clinics:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology care. Attending MD’s will expect the fellows during this
year to present evidence-based care guidelines from the literature
and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
81
learn the art of designating responsibilities for patients’ care to the
various team members. They will be guided in this development by
the attending MD’s.
Core competencies:
Patient Care
The fellow will be able to:
 Apply leadership and autonomy to an organized approach in the medical
management of a variety of solid tumors.
 Apply leadership and autonomy to an ability to integrate lab clinical data,
pathology results, and radiographic data to accurately diagnose and
evaluate patients with a solid tumor malignancy.
 Apply leadership and autonomy to competence in the prescription and
administration of chemotherapeutic agents.
 Apply leadership and autonomy in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply leadership and autonomy in the performance of appropriate
oncology based procedures; e.g., intrathecal chemotherapy
administration.
 Apply leadership and autonomy in the ability to function as a member of a
team to provide appropriate support to patients with solid tumors.
Medical Knowledge
The fellow will:
 Apply leadership and autonomy to describe the basic principles of a
variety of oncologic neoplasms and learn to effectively use this knowledge
to come up with an evidence-based treatment plan, searching sources for
evidence to support the fellow’s decision.
 Apply leadership and autonomy to the ability to use the accepted staging
and prognosticating tools available for oncologic malignancies for
determining appropriate treatment.
 Apply leadership and autonomy to the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will:
 Apply leadership and autonomy to actively engage their attending MD’s to
verbalize their own unique learning needs in the pursuit of oncologic
learning specific to the patient profile to which they have been exposed.
82




Apply leadership and autonomy in the review of the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
Apply leadership and autonomy to demonstrate the ability to reflect on
their own clinical practice in order to identify areas for improvement.
Apply leadership and autonomy to demonstrate the capability to critically
appraise the literature for a given solid tumor and to incorporate it into
their practice and decision-making.
Apply leadership and autonomy to demonstrate the ability to describe,
explain and clarify a problem and to identify and incorporate new
information to optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply leadership and autonomy to demonstrate the ability to interact in an
appropriate therapeutic relationship with patients and families.
 Apply leadership and autonomy to demonstrate the ability to effectively
communicate with patients regarding all aspects of their care including a
new diagnosis, relapse or transition to end-of-life care.
 Apply leadership and autonomy to maintain an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
UW oncology clinic.
 Apply leadership and autonomy to demonstrate the ability to manage
areas of conflict and to negotiate appropriate resolutions to these
challenges.
 Apply leadership and autonomy to demonstrate the ability to give critical
and praiseworthy feedback to subordinate learners to help those learners
along their paths.
 Apply leadership and autonomy to satisfactorily discuss a chemotherapy
treatment plan with a patient incorporating the process of informed
consent.
o It is expected that fellows during the third year will be independent
and will apply autonomous leadership to obtain consent for
treatment for their patient population. The fellow will continue to
utilize the attending MD for guidance and support.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply leadership and autonomy in the ability to work and communicate
effectively in the outpatient clinic with all members of the healthcare team,
and fulfill stated promises and obligations to patients and staff (OCRN,
pharmacist, scheduler, medical assistant, triage, and patients).
83



Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
Apply leadership and autonomy in the ability to become an effective
educator of learners on the team.
Apply leadership and autonomy in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
 Apply leadership and autonomy in the ability to work effectively in the
outpatient clinic with all members of the healthcare team, and fulfill stated
promises and obligations to patients (OCRN, pharmacist, scheduler,
medical assistant, triage, patients).
 Apply leadership and autonomy in the ability to work effectively in the
outpatient clinic with all members of the healthcare team in the quality
improvement of care in the outpatient setting. (E.g., participation on the
Chemotherapy Council).
 Apply leadership and autonomy in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Apply leadership and autonomy in the ability to effectively engage
personnel and programs (i.e., nursing, social work, physical therapy, home
health care, etc.) necessary to provide optimal patient care.
Contacts for this Rotation:
Clinic Director: Dan Mulkerin, MD. Phone: 265-8047 dm2@medicine.wisc.edu
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
Clinic Manager: Susan Hanauer, R.N. 3-8266
Chemo Coordinator: Ellen Donehower, R.N. 3-8251
Clinic Secretary/Lead Worker: Peggy Harms, 3-9552
Other Info: Appointment Desk: 5-1700
Clinic Nurses Station: 5-0093
Nurse Triage 5-9986
Pharmacy 2-3421
84
27 April 2012
UW Hematolology Ward Service
Goals and Objectives
OVERVIEW:
The hematology service is a busy inpatient clinical service that cares for patients
with a variety of hematological diseases. The service tends to carry a predominance
of patients with acute leukemia, aggressive lymphoma, patients requiring an
inpatient stay for chemotherapy administration and patients with complications of
therapy – most often neutropenic fever/infection. The service usually is populated by
an attending, fellow, a senior resident, an intern and often one medical student and
pharmacy student. The service also is coordinated by two nurse practitioners who
are instrumental in assuring continuity between inpatient and outpatient care,
coordinating chemotherapy protocols and orders, teaching patients and assisting in
family communication.
GENERAL DESCRIPTION OF RESPONSIBILITIES:
The fellow is responsible for overall clinical supervision and management of all
inpatients for 6 of 7 days per week. For one day per week, the fellow will have a day
out of the hospital, without call and will sign-out their pager to the attending
physician. While on service, the fellow is expected to see and know the progress of
all patients each day. Usually, the fellow will round with the attending after “sit-down”
rounds each day, but may choose to round with the house staff in the morning or on
their own at other times schedule permitting. After plans are made in rounds, the
fellow is expected to provide oversight and leadership to the house staff in carrying
out the plans and assuring effective communication between the various parties
involved with the care of the patient. While on the inpatient service, the fellow should
cancel any morning clinics, but the fellow will always attend their continuity clinic or
any clinic assignment at the VA. The attending understands the need to cover the
service during these times.
The fellow should arrange a review of the patients at the end of the day prior to the
departure of the residents. This is particularly important on post-call days when the
house staff are mandated to leave by noon (please help assure they are off the ward
by that time). The fellow should assure a dictated H&P is completed on every patient
(this is usually delegated to the resident or intern). The fellow is not expected to write
a daily note but should be familiar with the clinical course of all patients. As fellows
become more experienced in the operation of the clinical hematology service, they
are expected to assume a greater leadership role on the team. An experienced
fellow (late second and third year) should exhibit the competence and comfort level
to function as a junior attending for the majority of the clinical problems seen on the
hematology service. An important objective for the hematology service is for first
year fellows to develop an organized approach to the diagnosis and treatment of
85
hematologic conditions seen on the service. By the second year, the objective is for
fellows to show expertise in the same areas for the common clinical problems.
All chemotherapy orders (“treatment plans” in EPIC) should be reviewed by the
fellow. After completing the fellow’s Chemotherapy Course and writing orders under
the supervision of the attending, the fellow will be expected to complete and submit
chemotherapy orders independently. The fellows should document in the electronic
chart via a short-note the attainment of consent for chemotherapy, the plan and
goals of therapy. Fellows should note that their sign-off alone is sufficient for
submitting orders, so they should always exercise care when assuming this
responsibility.
In the evening and on weekends, the fellow will take calls from the access center
coming from outpatients and occasionally outside physicians. The triage of these
calls is an important function that often involves critically ill patients and the need for
transfer to UW hospital. Calls from outside physicians for consultation or transfer
should be managed by the attending physician and the fellow should defer these
calls to the attending. It is important to note that the volume of calls at night can be
excessive and lead to excessive fatigue and stress. The fellow is encouraged to
involve the attending physician at any time for assistance with after-hours calls and
may negotiate respite if needed. If the attending is not responsive, the fellow should
discuss the issue with the fellowship director.
New admissions and significant clinical changes (especially unanticipated deaths)
involving hematology patients should be communicated promptly to the attending. All
admits, whether in transfer from outside hospitals, the clinic, or the ED, are to be
discussed with the attending.
The fellow is expected to help in our mission of educating the residents and medical
students. The fellow is responsible for searching the medical literature, providing
evidence-based support for our therapies, and assisting in the formal didactic
presentations to the residents. The house staff and fellows are expected to attend
the Friday hematology conference (12:15pm K4/418 UW hospital) and occasionally
present patients. The fellow should lead the effort to identify patients for conference,
assign the presentations to house staff when appropriate, and review the literature to
contribute to the practice-based learning for the hematology faculty.
OVERALL GOALS FOR THE ROTATION:
Fellows are expected to achieve the milestones listed below and to show
continued growth during each year of training; expected milestones are
discussed in more detail in the following section and are broken down by year in
training.
 To become adept at:
o Forming an organized approach in the diagnosis.
o Interpretation of test results.
o Medical inpatient management of varied hematologic diseases.
86



o Medical inpatient management of the complications of both
progressive disease and treatment-induced side effects.
To become adept at the ability to integrate clinical, radiographic, and
laboratory data to generate a differential diagnosis for a patient with a
hematologic illness.
To become adept at the ability to use the accepted staging and
prognosticating tools available for hematologic illnesses for determining
appropriate treatment.
To become an effective communicator with patients and patients’ families
regarding important aspects of a solid tumor diagnosis not limited to:
o Discussing a new diagnosis.
o Delivery of “bad news.”
o Discussion of disease recurrence or progression.
o Discussion of transition to end-of-life care.
o
To become adept at the ability to communicate in a respectful and
effective manner, the treatment options appropriate for the patient’s
unique circumstance.
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
Hematology patients to achieve competence in the inpatient setting.
 In their first year in the Clinics:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Oncology care. Attending MD’s will guide the
fellows during this year in the appropriate use of evidence-based
care guidelines and the literature in developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
87
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
expected to develop competence in the application of their
supervisory skills by involvement in and overseeing the education
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
Core competencies:
Patient Care
The fellow will:
 Learn competence in an organized approach in the medical management
of a variety of benign and malignant hematologic processes.
 Learn competence in an ability to integrate lab clinical data, pathology
results, and radiographic data to accurately diagnose and evaluate
patients with benign and malignant hematologic processes.
 Learn competence in the prescription and administration of
chemotherapeutic agents.
 Learn competence in recognizing and understanding the side effect
profiles of various chemotherapeutic agents.
 Learn competence in the performance of appropriate oncology-based
procedures; e.g., intrathecal chemotherapy administration and bone
marrow evaluation.
 Learn competence in the ability to function as a member of a team to
provide appropriate support to patients with benign and malignant
hematologic processes.
 Learn competence in the triage of night and weekend patient phone calls
providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
 Demonstrate competence in the ability to describe the basic principles of a
variety of benign and malignant hematologic processes and learn to
effectively use this knowledge to come up with an evidence-based
treatment plan, searching sources for evidence to support the fellow’s
decision.
 Demonstrate competence in the ability to use the accepted staging and
prognosticating tools available for benign and malignant hematologic
processes for determining appropriate treatment.
 Demonstrate competence in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
88


Demonstrate competence in the management of patients admitted with
complications of malignant disease and/or its treatment such as:
o Acute Leukemia
o ALL
o AML
o Myelodysplastic syndromes.
o Myeloproliferative syndromes.
o Aggressive Lymphomas.
o Immune mediated blood cell disorders.
o Sickle Cell Disease.
o Complications of chemotherapy.
o Neutropenic complications.
o Transition from active to palliative care in the appropriate
setting.
Achieve competent scores on the ASH in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Actively engaging their attending MD’s to verbalize their own unique
learning needs in the pursuit of hematologic learning specific to the patient
profile to which they have been exposed.
 Actively reviewing the electronic notes the fellow has written with the
attending physician to ensure they are complete, accurate, and entail a
thorough plan of care.
 Actively reflecting on their own clinical practice in order to identify areas
for improvement.
 Critically appraising the literature for given benign and malignant
hematologic processes and to incorporate it into their practice and
decision-making.
 Actively describing, explaining and clarifying a problem and identifying and
incorporating new information in order to better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians on the
UW Hematology Ward service.
89



Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
Demonstrate competence in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the first year will regularly be
observed and the encounter evaluated by the attending MD in
which the fellow obtains consent for treatment. After the
observation, the fellow should discuss with the attending the
encounter and any opportunities for improvement. These
encounters will be evaluated at the end of a 6 month period.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively on the UW Hematology Ward service with all members of the
healthcare team, and fulfill stated promises and obligations to patients and
staff (OCRN, pharmacist, scheduler, medical assistant, triage, and
patients).
 Demonstrate the ability to develop as a leader and a role-model for the
learner members of the treatment team (i.e., medical students and
residents).
 Demonstrate competence in the ability to become an effective educator of
learners on the team.
 Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Demonstrate competence in the prescription and administration of
chemotherapeutic agents.
 Demonstrate competence in the ability to work effectively on the UW
Hematology Ward service with all members of the healthcare team, and
fulfill stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Demonstrate competence in the ability to work effectively on the UW
Hematology Ward service with all members of the healthcare team in the
quality improvement of care in the outpatient setting. (E.g., participation on
the Chemotherapy Council).
90
 Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Demonstrate competence in the ability to effectively engage personnel




and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.
Demonstrate competence in the ability to lead multidisciplinary health team
rounds.
Demonstrate competence in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Demonstrate competence in the effective triage of night and weekend patient
phone calls that results in appropriate communication to involved parties and
follow-up plans.
Demonstrate competence in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
MILESTONES BY YEAR OF TRAINING--Year 2.
General Overview:
 As a second year learner, the fellow will work on applying the
fundamentals of inpatient care of Hematology patients.
 In their second year in the Clinics:
o Conditional Independence: Fellows are expected to be learning
more independence in their care of patients in their second year,
but still under the supervision of their attending MD’s. During this
year that they are applying the skills learned in their first year
towards more advanced Oncology care. Attending MD’s will expect
the fellows during this year to present evidence-based care
guidelines from the literature before developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will begin to have a more direct
supervisory role in their second year. They are expected to begin to
apply their supervisory skills and direct the education of residents
and medical students on the service. They will be expected to help
residents learn the methods best suited for evidence based care
and learning which they themselves learned in their first year of
fellowship. They will be guided in this development by the attending
MD’s.
91
Core competencies:
Patient Care
The fellow will be able to:
 Apply expertise to an organized approach in the medical management of a
variety of benign and malignant hematologic processes.
 Apply expertise to an ability to integrate lab clinical data, pathology results,
and radiographic data to accurately diagnose and evaluate patients with
benign and malignant hematologic processes.
 Apply expertise to competence in the prescription and administration of
chemotherapeutic agents.
 Apply expertise to competence in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply expertise to competence in the performance of appropriate
hematology based procedures; e.g., intrathecal chemotherapy
administration and bone marrow evaluation.
 Apply expertise to the ability to function as a member of a team to provide
appropriate support to patients with benign and malignant hematologic
processes.
 Apply expertise in the triage of night and weekend patient phone calls
providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
 Apply expertise to describe the basic principles of a variety of benign and
malignant hematologic processes and learn to effectively use this
knowledge to come up with an evidence-based treatment plan, searching
sources for evidence to support the fellow’s decision.
 Apply expertise to the ability to use the accepted staging and
prognosticating tools available for benign and malignant hematologic
processes malignancies for determining appropriate treatment.
 Apply expertise in the management of patients admitted with complications of
malignant disease and/or its treatment such as:
o Acute Leukemia
o Myelodysplastic syndromes
o Myeloproliferative syndromes
o Aggressive Lymphomas
o Immune mediated blood cell disorders
o Sickle Cell Disease
o Complications of chemotherapy
o Neutropenic complications
o Transition from active to palliative care in the appropriate setting.
92

Apply expertise to the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
 Achieve competent scores on the ASH in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will:
 Apply expertise to actively engage their attending MD’s to verbalize their
own unique learning needs in the pursuit of hematologic learning specific
to the patient profile to which they have been exposed.
 Apply expertise to review the electronic notes the fellow has written with
the attending physician to ensure they are complete, accurate, and entail
a thorough plan of care.
 Apply expertise to demonstrate the ability to reflect on their own clinical
practice in order to identify areas for improvement.
 Apply expertise to demonstrate the capability to critically appraise the
literature for a given benign and malignant hematologic processes and to
incorporate it into their practice and decision-making.
 Apply expertise to demonstrate the ability to describe, explain and clarify a
problem and to identify and incorporate new information to optimize
patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply expertise to demonstrate the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Apply expertise to demonstrate the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Apply expertise to maintain an appropriate level of professionalism with
the staff, midlevel providers and physicians in the UW Hematology Ward
service.
 Apply expertise to demonstrate the ability to manage areas of conflict and
to negotiate appropriate resolutions to these challenges.
 Apply expertise to demonstrate the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Apply expertise to satisfactorily discuss a chemotherapy treatment plan
with a patient incorporating the process of informed consent.
o It is expected that fellows during the second year will be competent
to obtain consent for treatment for their patient population. The
fellow will continue to discuss the encounter with the attending and
any opportunities for improvement.
93
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively on the
UW Hematology Ward service with all members of the healthcare team,
and fulfill stated promises and obligations to patients and staff (OCRN,
pharmacist, scheduler, medical assistant, triage, and patients).
 Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
 Apply expertise in the ability to become an effective educator of learners
on the team.
 Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
Systems-Based Practice
The fellow will:
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in the ability to work effectively on the UW Hematology
Ward service with all members of the healthcare team, and fulfill stated
promises and obligations to patients (OCRN, pharmacist, scheduler,
medical assistant, triage, patients).
 Apply expertise in the ability to work effectively on the UW Hematology
Ward service with all members of the healthcare team in the quality
improvement of care in the outpatient setting. (E.g., participation on the
Chemotherapy Council).
 Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
 Apply expertise in the ability to effectively engage personnel and programs




(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.
Apply expertise in the ability to lead multidisciplinary health team rounds.
Apply expertise in teaching techniques and appreciation of educational
needs of residents by providing appropriate, level-specific didactics.
Apply expertise in the effective triage of night and weekend patient phone
calls that results in appropriate communication to involved parties and followup plans.
Apply expertise in the ability to identify when multispecialty consultation is
necessary and foster professional relationships with clinicians across a wide
variety of specialties.
94
MILESTONES BY YEAR OF TRAINING--Year 3.
General Overview:
 As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of inpatient care of Hematology
patients, relying on the attending for expertise and guidance.
 In their third year on the Ward service:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology care. Attending MD’s will expect the fellows during this
year to present evidence-based care guidelines from the literature
and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
learn the art of designating responsibilities for patients’ care to the
various team members. They will be guided in this development by
the attending MD’s.
Core competencies:
Patient Care
The fellow will be able to:
 Apply leadership and autonomy to an organized approach in the medical
management of a variety of benign and malignant hematologic processes.
 Apply leadership and autonomy to an ability to integrate lab clinical data,
pathology results, and radiographic data to accurately diagnose and
evaluate patients with benign and malignant hematologic processes.
 Apply leadership and autonomy to competence in the prescription and
administration of chemotherapeutic agents.
 Apply leadership and autonomy in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
95



Apply leadership and autonomy in the performance of appropriate
hematology based procedures; e.g., intrathecal chemotherapy
administration and bone marrow evaluation.
Apply leadership and autonomy in the ability to function as a member of a
team to provide appropriate support to patients with benign and malignant
hematologic processes.
Apply leadership and autonomy in the triage of night and weekend patient
phone calls providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
 Apply leadership and autonomy to describe the basic principles of a
variety of benign and malignant hematologic processes and learn to
effectively use this knowledge to come up with an evidence-based
treatment plan, searching sources for evidence to support the fellow’s
decision.
 Apply leadership and autonomy to the ability to use the accepted staging
and prognosticating tools available for benign and malignant hematologic
processes malignancies for determining appropriate treatment.
 Apply leadership and autonomy in the management of patients admitted with
complications of malignant disease and/or its treatment such as:
o Acute spinal cord compression.
o New central nervous system metastases.
o Intractable chemotherapy-induced nausea and vomiting.
o Neutropenic fever.
o Newly diagnosed aggressive malignancy.
o Obstructive complications of cancer.
o Complications of radiotherapy.
o Transitions from active antineoplastic therapy to supportive
care/hospice.
 Apply expertise to the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
 Achieve competent scores on the ASH in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.

Practice-Based Learning and Improvement
The fellow will:
 Apply leadership and autonomy to actively engage their attending MD’s to
verbalize their own unique learning needs in the pursuit of hematologic
learning specific to the patient profile to which they have been exposed.
 Apply leadership and autonomy in the review of the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
96



Apply leadership and autonomy to demonstrate the ability to reflect on
their own clinical practice in order to identify areas for improvement.
Apply leadership and autonomy to demonstrate the capability to critically
appraise the literature for given benign and malignant hematologic
processes and to incorporate it into their practice and decision-making.
Apply leadership and autonomy to demonstrate the ability to describe,
explain and clarify a problem and to identify and incorporate new
information to optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply leadership and autonomy to demonstrate the ability to interact in an
appropriate therapeutic relationship with patients and families.
 Apply leadership and autonomy to demonstrate the ability to effectively
communicate with patients regarding all aspects of their care including a
new diagnosis, relapse or transition to end-of-life care.
 Apply leadership and autonomy to maintain an appropriate level of
professionalism with the staff, midlevel providers and physicians on the
UW Hematology Ward service.
 Apply leadership and autonomy to demonstrate the ability to manage
areas of conflict and to negotiate appropriate resolutions to these
challenges.
 Apply leadership and autonomy to demonstrate the ability to give critical
and praiseworthy feedback to subordinate learners to help those learners
along their paths.
 Apply leadership and autonomy to satisfactorily discuss a chemotherapy
treatment plan with a patient incorporating the process of informed
consent.
o It is expected that fellows during the third year will be independent
and will apply autonomous leadership to obtain consent for
treatment for their patient population. The fellow will continue to
utilize the attending MD for guidance and support.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply leadership and autonomy in the ability to work and communicate
effectively on the UW Hematology Ward service with all members of the
healthcare team, and fulfill stated promises and obligations to patients and
staff (OCRN, pharmacist, scheduler, medical assistant, triage, and
patients).
 Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
97


Apply leadership and autonomy in the ability to become an effective
educator of learners on the team.
Apply leadership and autonomy in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
 Apply leadership and autonomy in the ability to work effectively on the UW
Hematology Ward service with all members of the healthcare team, and
fulfill stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Apply leadership and autonomy in the ability to work effectively on the UW
Hematology Ward service with all members of the healthcare team in the
quality improvement of care in the outpatient setting. (E.g., participation on
the Chemotherapy Council).
 Apply leadership and autonomy in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Apply leadership and autonomy in the ability to effectively engage




personnel and programs (i.e., nursing, social work, physical therapy, home
health care, etc.) necessary to provide optimal patient care.
Apply leadership and autonomy in the ability to lead multidisciplinary health
team rounds.
Apply leadership and autonomy in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Apply leadership and autonomy in the effective triage of night and weekend
patient phone calls that results in appropriate communication to involved
parties and follow-up plans.
Apply leadership and autonomy in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
Contacts for this Rotation:
Clinic Director: Dan Mulkerin, MD. Phone: 265-8047 dm2@medicine.wisc.edu
B6/6 Director: Vicki Hubbard
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
98
27 April 2012
UW Hematolology Outpatient Clinics
Rotation
Goals and Objectives
OVERVIEW:
The UW Hematology faculty all have outpatient clinics that care for patients with a
variety of benign and malignant hematologic disorders. The clinics are generally
organized around an attending with a particular disease focus, a nurse that is usually
familiar with the patients seen in the clinic, a medical assistant and sometimes a
nurse practitioner. There is a “triage” service operated by a rotating group of RN’s
and MA’s that will field outside calls regarding laboratory values, follow-up
schedules, medication refills and general questions. Calls pertaining to new health
issues will be forwarded to the physician or fellow responsible for the patient when
clinically indicated in the judgment of the RN.
DEFINITIONS:
Continuity clinics:
The fellows will participate in one half-day clinic per week during their 3-year
training program that will include either oncology or hematology disciplines. This
clinic will exist in solid 6-month blocks and is deemed the “continuity” clinic. The
fellow will attend every week regardless of the other assignments and will have
no excused absences due to ward responsibilities. The continuity clinic may be a
UW or VA clinic and will preferentially be scheduled in the afternoon to avoid
conflict with rounding times on the inpatient service. In this clinic, the fellow must
accrue a group of patients that can be identified by the continuity with which the
patients return to see the fellow. If the fellow perceives that patients are not
returning to their schedule, they should discuss this with the attending or program
director. These clinics serve to provide the fellows with a cadre of regular
patients with regular follow up to help them learn the “ins-and-outs” of solid tumor
patient care, communication and the delivery of health care within various
systems at the UW.
Non-Continuity Clinics:
The fellows will participate in 1 to 4 half-day clinics per week that will include
oncology or hematology disciplines, depending on their year in training. These
clinics will exist in 4-month blocks and are deemed the “non-continuity” clinics.
The fellow will attend every week, but will be excused from these clinics for
competing ward responsibilities. The non-continuity clinic may be a UW or VA
clinic and will preferentially be scheduled in the afternoon to avoid conflict with
rounding times on the inpatient service. While the fellows may establish a cadre
of regular follow-up patients during these blocks that is not the focus of these
99
clinics. These clinics serve to further the exposure to different types of solid
tumors based on organ system.
GENERAL DESCRIPTION OF RESPONSIBILITIES:
The fellows will participate in 3 to 4 half-day clinics per week that will include
oncology and hematology disciplines. One half-day clinic per week is deemed the
“continuity” clinic that the fellow will attend every week regardless of the other
assignments. If a fellow does not know which . The continuity clinic may be a UW or
VA clinic and will preferentially be scheduled in the afternoon to avoid conflict with
rounding times on the inpatient service.
Each new fellow will be assigned to an attending physician’s clinic and all patient
visits to the fellow in clinic will be staffed by that physician. There is not a “fellows”
clinic per se. The ACGME requires that the fellow stay within a particular clinic for at
least 6 months, but they may stay in any particular clinic for their entire fellowship if
acceptable to the fellow and clinic attending. The attending physicians have clinics
organized by their own clinical and research interests. A fellow will find the
experiences in different clinics to vary greatly with respect to the types of diagnoses
seen and general experience. For this reason, all fellows will be rotated to work with
different UW faculty members during their fellowship. While in clinic, the fellow must
accrue a group of patients that can be identified by the continuity with which the
patients return to see the fellow. If the fellow perceives that patients are not returning
to their schedule, they should discuss this with the attending or program director.
The fellow should assume primary responsibility for all patients they see in their
clinic. In addition to patient encounters, the duties include: dictating all physician
visits, writing chemotherapy orders, calling patients with lab results, following up on
diagnostic tests, discussing issues with family, etc. Essentially, the fellow should
assume all responsibilities required to effectively care for the outpatient and facilitate
transitions between inpatient and outpatient care. Each patient visit should be staffed
by the attending physician. The attending should see all patients in clinic as they are
ultimately responsible for the care. All dictations need to be signed by the attending.
The charge codes are required to be completed by the attending, but the fellow
should discuss the various charges and should be aware of the connection between
the service provided and the charges applied.
OVERALL GOALS FOR THE ROTATION:
Fellows are expected to achieve the milestones listed below and to show
continued growth during each year of training; expected milestones are
discussed in more detail in the following section and are broken down by year in
training.
 To become adept at:
o Forming an organized approach in the diagnosis.
o Interpretation of test results.
o Medical outpatient management of varied hematologic diseases.
o Medical outpatient management of the complications of both
progressive disease and treatment-induced side effects.
100



To become adept at the ability to integrate clinical, radiographic, and
laboratory data to generate a differential diagnosis for a patient with a
hematologic illness.
To become adept at the ability to use the accepted staging and
prognosticating tools available for hematologic illnesses for determining
appropriate treatment.
To become an effective communicator with patients and patients’ families
regarding important aspects of a solid tumor diagnosis not limited to:
o Discussing a new diagnosis.
o Delivery of “bad news.”
o Discussion of disease recurrence or progression.
o Discussion of transition to end-of-life care.
o
To become adept at the ability to communicate in a respectful and
effective manner, the treatment options appropriate for the patient’s
unique circumstance.
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
Hematology patients to achieve competence in the inpatient setting.
 In their first year in the Clinics:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Oncology care. Attending MD’s will guide the
fellows during this year in the appropriate use of evidence-based
care guidelines and the literature in developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
101
expected to develop competence in the application of their
supervisory skills by involvement in and overseeing the education
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
Core competencies:
Patient Care
The fellow will:
 Learn competence in an organized approach in the medical management
of a variety of benign and malignant hematologic processes.
 Learn competence in an ability to integrate lab clinical data, pathology
results, and radiographic data to accurately diagnose and evaluate
patients with benign and malignant hematologic processes.
 Learn competence in the prescription and administration of
chemotherapeutic agents.
 Learn competence in recognizing and understanding the side effect
profiles of various chemotherapeutic agents.
 Learn competence in the performance of appropriate hematology-based
procedures; e.g., intrathecal chemotherapy administration and bone
marrow evaluation.
 Learn competence in the ability to function as a member of a team to
provide appropriate support to patients with benign and malignant
hematologic processes.
 Learn competence in the performance and interpretation of a bone marrow
biopsy and aspirate with or without conscious sedation.
o The fellow will need to become certified to supervise conscious
sedation according to hospital policy (see the hematology website for
details).
o The fellow will be directly supervised by the attending physician until
“certified” to perform the procedure independently. Certification
requires the observation of at least 5 procedures with at least 3
evaluated as “competent”. In addition, none of the 5 procedures
should require assistance by the attending.
o After the fellow is “certified” to perform, they will need to complete all
bone marrow biopsy procedures performed by the fellow in MEDHUB.
 Learn competence in the performance of a lumbar puncture or Ommaya
reservoir tap with administration of intrathecal chemotherapy.
Medical Knowledge
The fellow will:
 Demonstrate competence in the ability to describe the basic principles of a
variety of benign and malignant hematologic processes and learn to
effectively use this knowledge to come up with an evidence-based
102





treatment plan, searching sources for evidence to support the fellow’s
decision.
Demonstrate competence in the ability to use the accepted staging and
prognosticating tools available for benign and malignant hematologic
processes for determining appropriate treatment with a focus on using the:
o International prognostic staging system (IPSS) in myelodysplastic
syndrome
o International staging system (ISS) in multiple myeloma
o International prognostic index (IPI) in large cell lymphoma
o Pretransplant assessment of mortality (PAM) score in transplantation
(http://cdsweb.fhcrc.org/pam/)
o Cytogenetics and molecular studies in acute leukemia
Demonstrate competence in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
Demonstrate competence in an organized approach in the diagnosis,
interpretation of test results, and medical management of a variety of
undifferentiated hematologic disorders with a focus on:
o Anemia
o Pancytopenia
o Isolated quantitative abnormalities of white cells and platelets
o Splenomegaly
o Lymphadenopathy
o Thrombosis and hemostasis
o Monoclonal immunoglobulins
o Immunodeficiency
o Complications of autoimmune diseases
o Complications of solid organ transplantation
o Hereditary hemolytic diseases
o Abnormalities of iron
Demonstrate competence in the management of patients admitted with
complications of malignant disease and/or its treatment such as:
o Acute Leukemia
o ALL
o AML
o Myelodysplastic syndromes.
o Myeloproliferative syndromes.
o Aggressive Lymphomas.
o Immune mediated blood cell disorders.
o Sickle Cell Disease.
o Complications of chemotherapy.
o Neutropenic complications.
o Transition from active to palliative care in the appropriate
setting.
Achieve competent scores on the ASH in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
103
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Demonstrate competence by actively engaging their attending MD’s to
verbalize their own unique learning needs in the pursuit of hematologic
learning specific to the patient profile to which they have been exposed.
 Demonstrate competence by actively reviewing the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Demonstrate competence by actively reflecting on their own clinical practice
in order to identify areas for improvement.
 Demonstrate competence by critically appraising the literature for given
benign and malignant hematologic processes and to incorporate it into
their practice and decision-making.
 Demonstrate competence by actively describing, explaining and clarifying a
problem and identifying and incorporating new information in order to
better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians on the
UW Hematology Ward service.
 Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
 Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Demonstrate competence in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the first year will regularly be
observed and the encounter evaluated by the attending MD in
which the fellow obtains consent for treatment. After the
observation, the fellow should discuss with the attending the
encounter and any opportunities for improvement. These
encounters will be evaluated at the end of a 6 month period.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
104
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively on the UW Outpatient Hematology clinic with all members of
the healthcare team, and fulfill stated promises and obligations to patients
and staff (OCRN, pharmacist, scheduler, medical assistant, triage, and
patients).
 Demonstrate competence by in the ability to develop as a leader and a rolemodel for the learner members of the treatment team (i.e., medical
students and residents).
 Demonstrate competence in the ability to become an effective educator of
learners on the team.
 Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Demonstrate competence in the prescription and administration of
chemotherapeutic agents.
 Demonstrate competence in the ability to work effectively on the UW
Outpatient Hematology clinic with all members of the healthcare team, and
fulfill stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Demonstrate competence in the ability to work effectively on the UW
Outpatient Hematology clinic with all members of the healthcare team in
the quality improvement of care in the outpatient setting. (E.g.,
participation on the Chemotherapy Council).
 Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Demonstrate competence in the ability to effectively engage personnel



and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.
Demonstrate competence in the ability to lead multidisciplinary health team
rounds.
Demonstrate competence in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Demonstrate competence in the effective triage of night and weekend patient
phone calls that results in appropriate communication to involved parties and
follow-up plans.
105

Demonstrate competence in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
MILESTONES BY YEAR OF TRAINING--Year 2.
General Overview:
 As a second year learner, the fellow will work on applying the
fundamentals of inpatient care of Hematology patients.
 In their second year in the Clinics:
o Conditional Independence: Fellows are expected to be learning
more independence in their care of patients in their second year,
but still under the supervision of their attending MD’s. During this
year that they are applying the skills learned in their first year
towards more advanced Oncology care. Attending MD’s will expect
the fellows during this year to present evidence-based care
guidelines from the literature before developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will begin to have a more direct
supervisory role in their second year. They are expected to begin to
apply their supervisory skills and direct the education of residents
and medical students on the service. They will be expected to help
residents learn the methods best suited for evidence based care
and learning which they themselves learned in their first year of
fellowship. They will be guided in this development by the attending
MD’s.
Core competencies:
Patient Care
The fellow will:
 Apply expertise in an organized approach in the medical management of a
variety of benign and malignant hematologic processes.
 Apply expertise in an ability to integrate lab clinical data, pathology results,
and radiographic data to accurately diagnose and evaluate patients with
benign and malignant hematologic processes.
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in recognizing and understanding the side effect profiles of
various chemotherapeutic agents.
106




Apply expertise in the performance of appropriate hematology-based
procedures; e.g., intrathecal chemotherapy administration and bone
marrow evaluation.
Apply expertise in the ability to function as a member of a team to provide
appropriate support to patients with benign and malignant hematologic
processes.
Apply expertise in the performance and interpretation of a bone marrow
biopsy and aspirate with or without conscious sedation.
o The fellow will need to become certified to supervise conscious
sedation according to hospital policy (see the hematology website for
details).
o The fellow will be directly supervised by the attending physician until
“certified” to perform the procedure independently. Certification
requires the observation of at least 5 procedures with at least 3
evaluated as “competent”. In addition, none of the 5 procedures
should require assistance by the attending.
o After the fellow is “certified” to perform, they will need to complete all
bone marrow biopsy procedures performed by the fellow in MEDHUB.
Apply expertise in the performance of a lumbar puncture or Ommaya
reservoir tap with administration of intrathecal chemotherapy.
Medical Knowledge
The fellow will:
 Apply expertise in the ability to describe the basic principles of a variety of
benign and malignant hematologic processes and learn to effectively use
this knowledge to come up with an evidence-based treatment plan,
searching sources for evidence to support the fellow’s decision.
 Apply expertise in the ability to use the accepted staging and
prognosticating tools available for benign and malignant hematologic
processes for determining appropriate treatment with a focus on using the:
o International prognostic staging system (IPSS) in myelodysplastic
syndrome
o International staging system (ISS) in multiple myeloma
o International prognostic index (IPI) in large cell lymphoma
o Pretransplant assessment of mortality (PAM) score in transplantation
(http://cdsweb.fhcrc.org/pam/)
o Cytogenetics and molecular studies in acute leukemia
 Apply expertise in the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
 Apply expertise in an organized approach in the diagnosis, interpretation of
test results, and medical management of a variety of undifferentiated
hematologic disorders with a focus on:
o Anemia
o Pancytopenia
o Isolated quantitative abnormalities of white cells and platelets
107


o Splenomegaly
o Lymphadenopathy
o Thrombosis and hemostasis
o Monoclonal immunoglobulins
o Immunodeficiency
o Complications of autoimmune diseases
o Complications of solid organ transplantation
o Hereditary hemolytic diseases
o Abnormalities of iron
Apply expertise in the management of patients admitted with complications
of malignant disease and/or its treatment such as:
o Acute Leukemia
o ALL
o AML
o Myelodysplastic syndromes.
o Myeloproliferative syndromes.
o Aggressive Lymphomas.
o Immune mediated blood cell disorders.
o Sickle Cell Disease.
o Complications of chemotherapy.
o Neutropenic complications.
o Transition from active to palliative care in the appropriate
setting.
Achieve competent scores on the ASH in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Apply expertise by actively engaging their attending MD’s to verbalize their
own unique learning needs in the pursuit of hematologic learning specific
to the patient profile to which they have been exposed.
 Apply expertise by actively reviewing the electronic notes the fellow has
written with the attending physician to ensure they are complete, accurate,
and entail a thorough plan of care.
 Apply expertise by actively reflecting on their own clinical practice in order
to identify areas for improvement.
 Apply expertise by critically appraising the literature for given benign and
malignant hematologic processes and to incorporate it into their practice
and decision-making.
 Apply expertise by actively describing, explaining and clarifying a problem
and identifying and incorporating new information in order to better
optimize patient care.
Interpersonal and Communication Skills
The fellow will:
108






Apply expertise in the ability to interact in an appropriate therapeutic
relationship with patients and families.
Apply expertise in the ability to effectively communicate with patients
regarding all aspects of their care including a new diagnosis, relapse or
transition to end-of-life care.
Apply expertise in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
UW Outpatient Hematology clinic.
Apply expertise in the ability to manage areas of conflict and to negotiate
appropriate resolutions to these challenges.
Apply expertise in the ability to give critical and praiseworthy feedback to
subordinate learners to help those learners along their paths.
Apply expertise in the ability to satisfactorily discuss a chemotherapy
treatment plan with a patient incorporating the process of informed
consent.
o It is expected that fellows during the second year will be competent
to obtain consent for treatment for their patient population. The
fellow will continue to discuss the encounter with the attending and
any opportunities for improvement.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively in the
UW Outpatient Hematology clinic with all members of the healthcare team,
and fulfill stated promises and obligations to patients and staff (OCRN,
pharmacist, scheduler, medical assistant, triage, and patients).
 Apply expertise in the ability to develop as a leader and a role-model for
the learner members of the treatment team (i.e., medical students and
residents).
 Apply expertise in the ability to become an effective educator of learners
on the team.
 Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
Systems-Based Practice
The fellow will:
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in the ability to work effectively ion the UW Outpatient
Hematology clinic with all members of the healthcare team, and fulfill
stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
109

Apply expertise in the ability to work effectively in the UW Outpatient
Hematology clinic with all members of the healthcare team in the quality
improvement of care in the outpatient setting. (E.g., participation on the
Chemotherapy Council).
 Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
 Apply expertise in the ability to effectively engage personnel and programs




(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.
Apply expertise in the ability to lead multidisciplinary health team rounds.
Apply expertise in teaching techniques and appreciation of educational
needs of residents by providing appropriate, level-specific didactics.
Apply expertise in the effective triage of night and weekend patient phone
calls that results in appropriate communication to involved parties and followup plans.
Apply expertise in the ability to identify when multispecialty consultation is
necessary and foster professional relationships with clinicians across a wide
variety of specialties.
MILESTONES BY YEAR OF TRAINING--Year 3.
General Overview:
 As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of inpatient care of Hematology
patients, relying on the attending for expertise and guidance.
 In their third year on the Ward service:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology care. Attending MD’s will expect the fellows during this
year to present evidence-based care guidelines from the literature
and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
110
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
learn the art of designating responsibilities for patients’ care to the
various team members. They will be guided in this development by
the attending MD’s.
Core competencies:
Patient Care
The fellow will:
 Apply leadership and autonomy in an organized approach in the medical
management of a variety of benign and malignant hematologic processes.
 Apply leadership and autonomy in an ability to integrate lab clinical data,
pathology results, and radiographic data to accurately diagnose and
evaluate patients with benign and malignant hematologic processes.
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
 Apply leadership and autonomy in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply leadership and autonomy in the performance of appropriate
hematology-based procedures; e.g., intrathecal chemotherapy
administration and bone marrow evaluation.
 Apply leadership and autonomy in the ability to function as a member of a
team to provide appropriate support to patients with benign and malignant
hematologic processes.
 Apply leadership and autonomy in the performance and interpretation of a
bone marrow biopsy and aspirate with or without conscious sedation.
o The fellow will need to become certified to supervise conscious
sedation according to hospital policy (see the hematology website for
details).
o The fellow will be directly supervised by the attending physician until
“certified” to perform the procedure independently. Certification
requires the observation of at least 5 procedures with at least 3
evaluated as “competent”. In addition, none of the 5 procedures
should require assistance by the attending.
o After the fellow is “certified” to perform, they will need to complete all
bone marrow biopsy procedures performed by the fellow in MEDHUB.
 Apply leadership and autonomy in the performance of a lumbar puncture or
Ommaya reservoir tap with administration of intrathecal chemotherapy.
Medical Knowledge
The fellow will:
 Apply leadership and autonomy in the ability to describe the basic
principles of a variety of benign and malignant hematologic processes and
111




learn to effectively use this knowledge to come up with an evidence-based
treatment plan, searching sources for evidence to support the fellow’s
decision.
Apply leadership and autonomy in the ability to use the accepted staging
and prognosticating tools available for benign and malignant hematologic
processes for determining appropriate treatment with a focus on using the:
o International prognostic staging system (IPSS) in myelodysplastic
syndrome
o International staging system (ISS) in multiple myeloma
o International prognostic index (IPI) in large cell lymphoma
o Pretransplant assessment of mortality (PAM) score in transplantation
(http://cdsweb.fhcrc.org/pam/)
o Cytogenetics and molecular studies in acute leukemia
Apply leadership and autonomy in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
Apply leadership and autonomy in an organized approach in the diagnosis,
interpretation of test results, and medical management of a variety of
undifferentiated hematologic disorders with a focus on:
o Anemia
o Pancytopenia
o Isolated quantitative abnormalities of white cells and platelets
o Splenomegaly
o Lymphadenopathy
o Thrombosis and hemostasis
o Monoclonal immunoglobulins
o Immunodeficiency
o Complications of autoimmune diseases
o Complications of solid organ transplantation
o Hereditary hemolytic diseases
o Abnormalities of iron
Apply leadership and autonomy in the management of patients admitted
with complications of malignant disease and/or its treatment such as:
o Acute Leukemia
o ALL
o AML
o Myelodysplastic syndromes.
o Myeloproliferative syndromes.
o Aggressive Lymphomas.
o Immune mediated blood cell disorders.
o Sickle Cell Disease.
o Complications of chemotherapy.
o Neutropenic complications.
o Transition from active to palliative care in the appropriate
setting.
112

Achieve competent scores on the ASH in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Apply leadership and autonomy by actively engaging their attending MD’s
to verbalize their own unique learning needs in the pursuit of hematologic
learning specific to the patient profile to which they have been exposed.
 Apply leadership and autonomy by actively reviewing the electronic notes
the fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Apply leadership and autonomy by actively reflecting on their own clinical
practice in order to identify areas for improvement.
 Apply leadership and autonomy by critically appraising the literature for
given benign and malignant hematologic processes and to incorporate it
into their practice and decision-making.
 Apply leadership and autonomy by actively describing, explaining and
clarifying a problem and identifying and incorporating new information in
order to better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply leadership and autonomy in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Apply leadership and autonomy in the ability to effectively communicate
with patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Apply leadership and autonomy in the maintenance of an appropriate level
of professionalism with the staff, midlevel providers and physicians in the
UW Outpatient Hematology clinic.
 Apply leadership and autonomy in the ability to manage areas of conflict
and to negotiate appropriate resolutions to these challenges.
 Apply leadership and autonomy in the ability to give critical and
praiseworthy feedback to subordinate learners to help those learners
along their paths.
 Apply leadership and autonomy in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the third year will be independent
and will apply autonomous leadership to obtain consent for
treatment for their patient population. The fellow will continue to
utilize the attending MD for guidance and support.
113
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply leadership and autonomy in the ability to work and communicate
effectively in the UW Outpatient Hematology clinic with all members of the
healthcare team, and fulfill stated promises and obligations to patients and
staff (OCRN, pharmacist, scheduler, medical assistant, triage, and
patients).
 Apply leadership and autonomy in the ability to develop as a leader and a
role-model for the learner members of the treatment team (i.e., medical
students and residents).
 Apply leadership and autonomy in the ability to become an effective
educator of learners on the team.
 Apply leadership and autonomy in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
 Apply leadership and autonomy in the ability to work effectively ion the
UW Outpatient Hematology clinic with all members of the healthcare team,
and fulfill stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Apply leadership and autonomy in the ability to work effectively in the UW
Outpatient Hematology clinic with all members of the healthcare team in
the quality improvement of care in the outpatient setting. (E.g.,
participation on the Chemotherapy Council).
 Apply leadership and autonomy in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Apply leadership and autonomy in the ability to effectively engage


personnel and programs (i.e., nursing, social work, physical therapy, home
health care, etc.) necessary to provide optimal patient care.
Apply leadership and autonomy in the ability to lead multidisciplinary health
team rounds.
Apply leadership and autonomy in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
114


Apply leadership and autonomy in the effective triage of night and weekend
patient phone calls that results in appropriate communication to involved
parties and follow-up plans.
Apply leadership and autonomy in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
Contacts for this Rotation:
Clinic Director: Dan Mulkerin, MD. Phone: 265-8047 dm2@medicine.wisc.edu
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
Clinic Manager: Susan Hanauer, R.N. 3-8266 Chemo Coordinator: Ellen Donehower, R.N. 38251
Clinic Secretary/Lead Worker: Peggy Harms, 3-9552
Other Info: Appointment Desk: 5-1700
Clinic Nurses Station: 5-0093
Nurse Triage 5-9986
Pharmacy 2-3421
115
27 April 2012
UW Hematolology Ward Service
Goals and Objectives
OVERVIEW:
The overall goal of this rotation is for the fellow to develop those skills necessary for
effective consultation for hospitalized patients with benign and malignant
hematologic disorders that occur during hospitalization. The majority of the requests
pertain to blood cell abnormalities occurring as complications of surgical, medical, or
transplantation related care or hemostatic and thrombotic complications of medical
and surgical care.
GENERAL DESCRIPTION OF RESPONSIBILITIES:
The fellow is expected to assume a leadership role in managing the work-flow on the
service. Consults will be reported to the fellow primarily and the fellow is responsible
for triaging consults as they are received and managing the work load with the
attending and resident on service. The fellow is responsible for ensuring that all
consults are seen and staffed with 24 hours. The fellow will monitor the active patient
list and will ensure that follow-up, if needed is carried through until sign-off or
discharge. If outpatient hematology follow-up is needed, the fellow will assure
appropriate plans are scheduled and the plans communicated to the referring
physician and patient. The fellow may choose to transfer a patient to the inpatient
hematology service if the primary problem is perceived to be hematologic and
ongoing inpatient hematologic care is needed. This should be discussed with the
inpatient attending physician prior to any transfer of service. Generally, we expect
the fellow to assure that verbal contact is made with the primary team after
consultation to assure adequate communication of the recommendations.
While on the consult service, the fellow should arrange to spend time in the special
coagulation laboratory to review the laboratory procedures relevant to the care of
hematology patients. The fellow is expected to spend time at the bench with the
technologists that operate the laboratory. The fellow may assist or observe as
various laboratory tests are performed. At a minimum, the fellow should observe a
PT, PTT, platelet aggregation studies, an ELISA (HIT, protein C or S, etc), and if
possible, a coagulation inhibitor study. It is important to learn technical aspects of the
assays, including principle action, sensitivity, specificity, technical limitations and
appropriate application. The lead technologist will administer a written test for selfevaluation the end of the didactic session in the laboratory.
In the evening and on weekends, the fellow will take calls from the access center
coming from providers for new consults and occasionally outside physicians. The
triage of these calls is an important function that may involves critically ill patients
and the need for transfer to UW hospital (these calls generally should go to the
Heme Ward person on call). Calls from outside physicians for consultation or
116
transfer should be managed by the attending physician and the fellow should defer
these calls to the attending. It is important to note that the volume of calls at night
can be excessive and lead to excessive fatigue and stress. The fellow is encouraged
to involve the attending physician at any time for assistance with after-hours calls
and may negotiate respite if needed. If the attending is not responsive, the fellow
should discuss the issue with the fellowship director.
OVERALL GOALS FOR THE ROTATION:
Fellows are expected to achieve the milestones listed below and to show
continued growth during each year of training; expected milestones are
discussed in more detail in the following section and are broken down by year in
training.


To become proficient in the inpatient evaluation of patients with undefined
benign and malignant hematologic conditions.
To become an effective consultant in the discipline of hematology.
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
Hematology patients to achieve competence in the inpatient setting.
 In their first year in the Clinics:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Oncology care. Attending MD’s will guide the
fellows during this year in the appropriate use of evidence-based
care guidelines and the literature in developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
117
expected to develop competence in the application of their
supervisory skills by involvement in and overseeing the education
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
Core competencies:
Patient Care
The fellow will:
 Learn competence in an organized approach in the medical management
of a variety of benign and malignant hematologic processes.
 Learn competence in an ability to integrate lab clinical data, pathology
results, and radiographic data to accurately diagnose and evaluate
patients with benign and malignant hematologic processes.
 Learn competence in the prescription and administration of
chemotherapeutic agents.
 Learn competence in recognizing and understanding the side effect
profiles of various chemotherapeutic agents.
 Learn competence in the performance of appropriate oncology-based
procedures; e.g., intrathecal chemotherapy administration and bone
marrow evaluation.
o The fellow will need to become certified to supervise conscious
sedation according to hospital policy.
o Satisfactorily perform and interpret a bone marrow biopsy and aspirate
with or without conscious sedation.
 Integrate clinical data with laboratory findings from the special coagulation lab
to effectively evaluate basic coagulation disorders and monitor anticoagulant
and hemostatic medications.
 Demonstrate the ability to recognize basic findings on blood smears within
the clinical context of the patient.
o While on service, the fellow is responsible for having peripheral blood
smears made for review by the consult service. The fellow is expected
to lead the review of the blood smear with an attending observing
using one of the available teaching microscopes. The fellow will be
evaluated on their ability to review the blood smear and interpret the
findings within the context of the clinical question.
 Learn competence in the ability to function as a member of a team to
provide appropriate support to patients with benign and malignant
hematologic processes.
 Learn competence in the triage of night and weekend patient phone calls
providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
118







Demonstrate competence in the ability to describe the basic principles of a
variety of benign and malignant hematologic processes and learn to
effectively use this knowledge to come up with an evidence-based
treatment plan, searching sources for evidence to support the fellow’s
decision.
Demonstrate competence in the ability to use the accepted staging and
prognosticating tools available for benign and malignant hematologic
processes for determining appropriate treatment.
Demonstrate competence in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
Demonstrate competence in an organized, evidence-based approach in the
evaluation and management of patients with benign hematologic disorders
with a focus on:
o Quantitative blood cell abnormalities
o Immune mediated blood cell destruction
o Hematological complications associated with solid organ
transplantation
o Hemostatic complications following surgery
o Heparin associated thrombocytopenia with/without thrombosis
o Disseminated intravascular coagulation
o Inherited and acquired thrombophilia and bleeding disorders.
Demonstrate competence in the descrition of assays performed in the special
coagulation laboratory with an emphasis on:
o The importance of sample collection and handling on test results
o Methods for INR, PTT, factor assays, factor inhibitor assays,
antiphospholipid/lupus antibody assays, platelet function testing, and
ELISAs.
Demonstrate competence in the consultative management of patients
admitted with complications of malignant disease and/or its treatment such
as:
o Acute Leukemia
o ALL
o AML
o Myelodysplastic syndromes.
o Myeloproliferative syndromes.
o Aggressive Lymphomas.
o Immune mediated blood cell disorders.
o Sickle Cell Disease.
o Complications of chemotherapy.
o Neutropenic complications.
o Transition from active to palliative care in the appropriate
setting.
Achieve competent scores on the ASH in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
119
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Demonstrate competence by actively engaging their attending MD’s to
verbalize their own unique learning needs in the pursuit of hematologic
learning specific to the patient profile to which they have been exposed.
 Demonstrate competence by actively reviewing the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Demonstrate competence by actively reflecting on their own clinical
practice in order to identify areas for improvement.
 Demonstrate competence by critically appraising the literature for given
benign and malignant hematologic processes and to incorporate it into
their practice and decision-making.
 Demonstrate competence by actively describing, explaining and clarifying
a problem and identifying and incorporating new information in order to
better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians on the
UW Inpatient Hematology Consult service.
 Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
 Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
 Demonstrate competence in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the first year will regularly be
observed and the encounter evaluated by the attending MD in
which the fellow obtains consent for treatment. After the
observation, the fellow should discuss with the attending the
encounter and any opportunities for improvement. These
encounters will be evaluated at the end of a 6 month period.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
120
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively on the UW Inpatient Hematology Consult service with all
members of the healthcare team, and fulfill stated promises and
obligations to patients and staff (OCRN, pharmacist, scheduler, medical
assistant, triage, and patients).
 Demonstrate the ability to develop as a leader and a role-model for the
learner members of the treatment team (i.e., medical students and
residents).
 Demonstrate competence in the ability to become an effective educator of
learners on the team.
 Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Demonstrate competence in the prescription and administration of
chemotherapeutic agents.
 Demonstrate competence in the ability to work effectively on the UW
Inpatient Hematology Consult service with all members of the healthcare
team, and fulfill stated promises and obligations to patients (OCRN,
pharmacist, scheduler, medical assistant, triage, patients).
 Demonstrate competence in the ability to work effectively on the UW
Inpatient Hematology Consult service e with all members of the healthcare
team in the quality improvement of care in the outpatient setting. (E.g.,
participation on the Chemotherapy Council).
 Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Demonstrate competence in the ability to effectively engage personnel



and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.
Demonstrate competence in the ability to lead multidisciplinary health team
rounds.
Demonstrate competence in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Demonstrate competence in the effective triage of night and weekend patient
phone calls that results in appropriate communication to involved parties and
follow-up plans.
121

Demonstrate competence in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
MILESTONES BY YEAR OF TRAINING--Year 2.
General Overview:
 As a second year learner, the fellow will work on applying the
fundamentals of inpatient care of Hematology patients.
 In their second year in the Clinics:
o Conditional Independence: Fellows are expected to be learning
more independence in their care of patients in their second year,
but still under the supervision of their attending MD’s. During this
year that they are applying the skills learned in their first year
towards more advanced Oncology care. Attending MD’s will expect
the fellows during this year to present evidence-based care
guidelines from the literature before developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will begin to have a more direct
supervisory role in their second year. They are expected to begin to
apply their supervisory skills and direct the education of residents
and medical students on the service. They will be expected to help
residents learn the methods best suited for evidence based care
and learning which they themselves learned in their first year of
fellowship. They will be guided in this development by the attending
MD’s.
Core competencies:
Patient Care
The fellow will:
 Apply expertise in an organized approach in the medical management of a
variety of benign and malignant hematologic processes.
 Apply expertise in an ability to integrate lab clinical data, pathology results,
and radiographic data to accurately diagnose and evaluate patients with
benign and malignant hematologic processes.
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in recognizing and understanding the side effect profiles of
various chemotherapeutic agents.
122





Apply expertise in the performance of appropriate oncology-based
procedures; e.g., intrathecal chemotherapy administration and bone
marrow evaluation.
o The fellow will need to become certified to supervise conscious
sedation according to hospital policy.
o Satisfactorily perform and interpret a bone marrow biopsy and aspirate
with or without conscious sedation.
Apply expertise in the integration of clinical data with laboratory findings from
the special coagulation lab to effectively evaluate basic coagulation disorders
and monitor anticoagulant and hemostatic medications.
Apply expertise in the ability to recognize basic findings on blood smears
within the clinical context of the patient.
o While on service, the fellow is responsible for having peripheral blood
smears made for review by the consult service. The fellow is expected
to lead the review of the blood smear with an attending observing
using one of the available teaching microscopes. The fellow will be
evaluated on their ability to review the blood smear and interpret the
findings within the context of the clinical question.
Apply expertise in the ability to function as a member of a team to provide
appropriate support to patients with benign and malignant hematologic
processes.
Apply expertise in the triage of night and weekend patient phone calls
providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
 Apply expertise in the ability to describe the basic principles of a variety of
benign and malignant hematologic processes and learn to effectively use
this knowledge to come up with an evidence-based treatment plan,
searching sources for evidence to support the fellow’s decision.
 Apply expertise in the ability to use the accepted staging and
prognosticating tools available for benign and malignant hematologic
processes for determining appropriate treatment.
 Apply expertise in the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
 Apply expertise in an organized, evidence-based approach in the evaluation
and management of patients with benign hematologic disorders with a focus
on:
o Quantitative blood cell abnormalities
o Immune mediated blood cell destruction
o Hematological complications associated with solid organ
transplantation
o Hemostatic complications following surgery
o Heparin associated thrombocytopenia with/without thrombosis
o Disseminated intravascular coagulation
123



o Inherited and acquired thrombophilia and bleeding disorders.
Apply expertise in the descrition of assays performed in the special
coagulation laboratory with an emphasis on:
o The importance of sample collection and handling on test results
o Methods for INR, PTT, factor assays, factor inhibitor assays,
antiphospholipid/lupus antibody assays, platelet function testing, and
ELISAs.
Apply expertise in the consultative management of patients admitted with
complications of malignant disease and/or its treatment such as:
o Acute Leukemia
o ALL
o AML
o Myelodysplastic syndromes.
o Myeloproliferative syndromes.
o Aggressive Lymphomas.
o Immune mediated blood cell disorders.
o Sickle Cell Disease.
o Complications of chemotherapy.
o Neutropenic complications.
o Transition from active to palliative care in the appropriate
setting.
Achieve competent scores on the ASH in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Apply expertise by actively engaging their attending MD’s to verbalize their
own unique learning needs in the pursuit of hematologic learning specific
to the patient profile to which they have been exposed.
 Apply expertise by actively reviewing the electronic notes the fellow has
written with the attending physician to ensure they are complete, accurate,
and entail a thorough plan of care.
 Apply expertise by actively reflecting on their own clinical practice in order
to identify areas for improvement.
 Apply expertise by critically appraising the literature for given benign and
malignant hematologic processes and to incorporate it into their practice
and decision-making.
 Apply expertise by actively describing, explaining and clarifying a problem
and identifying and incorporating new information in order to better
optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply expertise in the ability to interact in an appropriate therapeutic
relationship with patients and families.
124





Apply expertise in the ability to effectively communicate with patients
regarding all aspects of their care including a new diagnosis, relapse or
transition to end-of-life care.
Apply expertise in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians on the
UW Inpatient Hematology Consult service.
Apply expertise in the ability to manage areas of conflict and to negotiate
appropriate resolutions to these challenges.
Apply expertise in the ability to give critical and praiseworthy feedback to
subordinate learners to help those learners along their paths.
Apply expertise in the ability to satisfactorily discuss a chemotherapy
treatment plan with a patient incorporating the process of informed
consent.
o It is expected that fellows during the second year will be competent
to obtain consent for treatment for their patient population. The
fellow will continue to discuss the encounter with the attending and
any opportunities for improvement.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively on the
UW Inpatient Hematology Consult service with all members of the
healthcare team, and fulfill stated promises and obligations to patients and
staff (OCRN, pharmacist, scheduler, medical assistant, triage, and
patients).
 Apply expertise to develop as a leader and a role-model for the learner
members of the treatment team (i.e., medical students and residents).
 Apply expertise in the ability to become an effective educator of learners
on the team.
 Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
Systems-Based Practice
The fellow will:
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in the ability to work effectively on the UW Inpatient
Hematology Consult service with all members of the healthcare team, and
fulfill stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Apply expertise in the ability to work effectively on the UW Inpatient
Hematology Consult service e with all members of the healthcare team in
125
the quality improvement of care in the outpatient setting. (E.g.,
participation on the Chemotherapy Council).
 Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
 Apply expertise in the ability to effectively engage personnel and programs




(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.
Apply expertise in the ability to lead multidisciplinary health team rounds.
Apply expertise in teaching techniques and appreciation of educational
needs of residents by providing appropriate, level-specific didactics.
Apply expertise in the effective triage of night and weekend patient phone
calls that results in appropriate communication to involved parties and followup plans.
Apply expertise in the ability to identify when multispecialty consultation is
necessary and foster professional relationships with clinicians across a wide
variety of specialties.
MILESTONES BY YEAR OF TRAINING--Year 3.
General Overview:
 As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of inpatient care of Hematology
patients, relying on the attending for expertise and guidance.
 In their third year on the Ward service:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology care. Attending MD’s will expect the fellows during this
year to present evidence-based care guidelines from the literature
and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
126
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
learn the art of designating responsibilities for patients’ care to the
various team members. They will be guided in this development by
the attending MD’s.
Core competencies:
Patient Care
The fellow will:
 Apply leadership and autonomy in an organized approach in the medical
management of a variety of benign and malignant hematologic processes.
 Apply leadership and autonomy in an ability to integrate lab clinical data,
pathology results, and radiographic data to accurately diagnose and
evaluate patients with benign and malignant hematologic processes.
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
 Apply leadership and autonomy in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply leadership and autonomy in the performance of appropriate
oncology-based procedures; e.g., intrathecal chemotherapy administration
and bone marrow evaluation.
o The fellow will need to become certified to supervise conscious
sedation according to hospital policy.
o Satisfactorily perform and interpret a bone marrow biopsy and aspirate
with or without conscious sedation.
 Apply leadership and autonomy in the integration of clinical data with
laboratory findings from the special coagulation lab to effectively evaluate
basic coagulation disorders and monitor anticoagulant and hemostatic
medications.
 Apply leadership and autonomy in the ability to recognize basic findings on
blood smears within the clinical context of the patient.
o While on service, the fellow is responsible for having peripheral blood
smears made for review by the consult service. The fellow is expected
to lead the review of the blood smear with an attending observing
using one of the available teaching microscopes. The fellow will be
evaluated on their ability to review the blood smear and interpret the
findings within the context of the clinical question.
 Apply leadership and autonomy in the ability to function as a member of a
team to provide appropriate support to patients with benign and malignant
hematologic processes.
 Apply leadership and autonomy in the triage of night and weekend patient
phone calls providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
127







Apply leadership and autonomy in the ability to describe the basic
principles of a variety of benign and malignant hematologic processes and
learn to effectively use this knowledge to come up with an evidence-based
treatment plan, searching sources for evidence to support the fellow’s
decision.
Apply leadership and autonomy in the ability to use the accepted staging
and prognosticating tools available for benign and malignant hematologic
processes for determining appropriate treatment.
Apply leadership and autonomy in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
Apply leadership and autonomy in an organized, evidence-based approach
in the evaluation and management of patients with benign hematologic
disorders with a focus on:
o Quantitative blood cell abnormalities
o Immune mediated blood cell destruction
o Hematological complications associated with solid organ
transplantation
o Hemostatic complications following surgery
o Heparin associated thrombocytopenia with/without thrombosis
o Disseminated intravascular coagulation
o Inherited and acquired thrombophilia and bleeding disorders.
Apply leadership and autonomy in the descrition of assays performed in the
special coagulation laboratory with an emphasis on:
o The importance of sample collection and handling on test results
o Methods for INR, PTT, factor assays, factor inhibitor assays,
antiphospholipid/lupus antibody assays, platelet function testing, and
ELISAs.
Apply leadership and autonomy in the consultative management of patients
admitted with complications of malignant disease and/or its treatment such
as:
o Acute Leukemia
o ALL
o AML
o Myelodysplastic syndromes.
o Myeloproliferative syndromes.
o Aggressive Lymphomas.
o Immune mediated blood cell disorders.
o Sickle Cell Disease.
o Complications of chemotherapy.
o Neutropenic complications.
o Transition from active to palliative care in the appropriate
setting.
Apply leadership and autonomy scores on the ASH in-training exam for
their level of training (given in February of each year) and demonstrate
continued improvement over each of their 3 years in training.
128
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Apply leadership and autonomy by actively engaging their attending MD’s
to verbalize their own unique learning needs in the pursuit of hematologic
learning specific to the patient profile to which they have been exposed.
 Apply leadership and autonomy by actively reviewing the electronic notes
the fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Apply leadership and autonomy by actively reflecting on their own clinical
practice in order to identify areas for improvement.
 Apply leadership and autonomy by critically appraising the literature for
given benign and malignant hematologic processes and to incorporate it
into their practice and decision-making.
 Apply leadership and autonomy by actively describing, explaining and
clarifying a problem and identifying and incorporating new information in
order to better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply leadership and autonomy in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Apply leadership and autonomy in the ability to effectively communicate
with patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Apply leadership and autonomy in the maintenance of an appropriate level
of professionalism with the staff, midlevel providers and physicians on the
UW Inpatient Hematology Consult service.
 Apply leadership and autonomy in the ability to manage areas of conflict
and to negotiate appropriate resolutions to these challenges.
 Apply leadership and autonomy in the ability to give critical and
praiseworthy feedback to subordinate learners to help those learners
along their paths.
 Apply leadership and autonomy in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the third year will be independent
and will apply autonomous leadership to obtain consent for
treatment for their patient population. The fellow will continue to
utilize the attending MD for guidance and support.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
129
The fellow will:
 Apply leadership and autonomy in the ability to work and communicate
effectively on the UW Inpatient Hematology Consult service with all
members of the healthcare team, and fulfill stated promises and
obligations to patients and staff (OCRN, pharmacist, scheduler, medical
assistant, triage, and patients).
 Apply leadership and autonomy to develop as a leader and a role-model
for the learner members of the treatment team (i.e., medical students and
residents).
 Apply leadership and autonomy in the ability to become an effective
educator of learners on the team.
 Apply leadership and autonomy in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
 Apply leadership and autonomy in the ability to work effectively on the UW
Inpatient Hematology Consult service with all members of the healthcare
team, and fulfill stated promises and obligations to patients (OCRN,
pharmacist, scheduler, medical assistant, triage, patients).
 Apply leadership and autonomy in the ability to work effectively on the UW
Inpatient Hematology Consult service e with all members of the healthcare
team in the quality improvement of care in the outpatient setting. (E.g.,
participation on the Chemotherapy Council).
 Apply leadership and autonomy in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Apply leadership and autonomy in the ability to effectively engage




personnel and programs (i.e., nursing, social work, physical therapy, home
health care, etc.) necessary to provide optimal patient care.
Apply leadership and autonomy in the ability to lead multidisciplinary health
team rounds.
Apply leadership and autonomy in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Apply leadership and autonomy in the effective triage of night and weekend
patient phone calls that results in appropriate communication to involved
parties and follow-up plans.
Apply leadership and autonomy in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
130
Contacts for this Rotation:
**See the faculty consult schedule to determine the appropriate faculty member to contact prior to
the beginning of your rotation.**
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
131
27 April 2012
UW Bone Marrow Transplant (BMT) Ward
Service
Goals and Objectives
OVERVIEW:
The BMT ward service is devoted to patients who are preparing for, undergoing, or
suffering from complications of hematopoietic stem cell transplantation. The service
has few unscheduled admissions and most patients are well known to the service.
The census ranges from 5 to 12 patients that are cared for by a team composed of
an attending, two dedicated nurse practitioners (NP) and the fellow. Rarely the
service has a resident that is interested in BMT as an elective. The service has no
house staff coverage at any time, including evenings when the in-patient coverage is
provided by the Hospitalist service. The hospitalists will cover emergencies and new
admissions from 7 pm to 7 am through the week. The fellow and/or attending need
to cover both weekend days for emergencies or new admissions and therefore, must
be available by beeper and available to return to the hospital if needed on these
days.
GENERAL DESCRIPTION OF RESPONSIBILITIES:
The fellow is responsible for overall clinical supervision and management of all
inpatients for 6 of 7 days per week. For one day per week, the fellow will have a day
out of the hospital, without call and will sign-out their pager to the attending
physician. While on service, the fellow is expected to see and know the progress of
all patients each day, and will usually assume primary responsibility for some
patients (to be worked out with the NP). Usually, the fellow, NPs and attending will
see the patients together in the morning (8:30 to 9:00 a.m.) and formalize plans after
walk rounds. The fellow is expected to work with the NPs on service to coordinate
the care. At the end of the day, the fellow should review the patients with the NP and
also sign-out the patients in the evening. The fellow should assure a dictated H&P is
completed on every patient (often performed by the NPs), but if the fellow does not
dictate an admission note, they should nonetheless remain familiar with the patient
and clinical course.
On admission for a BMT, it is crucial that the patient and the pre-BMT evaluation of
every patient be reviewed for completeness, possible unrecognized contraindication
to transplant, or any new problem before the beginning of the conditioning regimen.
It is also important upon admission to spend time with the patient reviewing the
transplantation process and general clinical course. Lastly, the consents for
treatment need to be reviewed with patients and signed prior to beginning any
therapy. Although the consent process usually occurs prior to admission, it is
important to be sure consent was obtained prior to the patient beginning the
regimen, and to answer any lingering questions. One important responsibility of the
132
treating physician on the BMT service is to compose a complete H&P that
summarizes the patient’s course leading up to BMT, the rationale for transplantation,
the pre-BMT evaluation that demonstrated the patient’s eligibility for treatment, the
suitability of the allogeneic donor (if applicable), and a statement indicating that the
patient has given consent to proceed.
Most patients admitted for BMT will have a standard order set in BEACON. These
orders must be reviewed for accuracy and compliance with any protocol therapy that
is planned. Also, all doses of chemotherapy must be checked by the ordering
physician (and fellow) prior to submission. Most patients will need separate orders
for medications and any therapy that is not part of the BMT process. All patients that
will receive allogeneic transplants require a review of the donor information to assure
that the donor is eligible to donate (the donor must be eligible before the conditioning
regimen is started). There are times when a donor in deemed “ineligible” but
nonetheless suitable for transplantation. For example, all unrelated volunteer donors
from Europe are now “ineligible” because of the small risk of prior disease (“Mad
cow” disease) and the fact that all are evaluated outside the jurisdiction of the FDA.
In this situation, the reasons for ineligibility must be reviewed by the patient and this
consent documented in the H&P.
Many BMT patients are transitioned into the “high-risk” clinic protocol during the time
period early after transplantation when they may still require a high level of clinical
support, but do not otherwise require admission to the hospital. This protocol was
started to facilitate early discharge of patients. Patients on the high-risk” protocol list
usually continue to need regular fluids, transfusions, electrolyte support and are
often coming to clinic 2 to 3 days per week. These patients are escorted to the
treatment room upon arrival to clinic and lab tests, fluids, treatments, etc., started.
The fellow and NPs will cover these patients when they come to clinic. The first year
fellow should review the care plan of these patients with either the NP or the
attending physician prior to discharge from the clinic.
The BMT service varies greatly with respect to workload and number of patients.
When feasible, fellows are encouraged to come to clinic during any day with the
attending to participate in the outpatient care of the BMT patients. We especially
encourage the BMT fellow to see new patients referred for consideration of
transplantation.
OVERALL GOALS FOR THE ROTATION:
Fellows are expected to achieve the milestones listed below and to show
continued growth during each year of training; expected milestones are
discussed in more detail in the following section and are broken down by year in
training.
 Demonstrate an organized approach in the management of patients
undergoing hematopoietic stem cell transplantation (HSCT) with focus on:
o Determining when transplantation is appropriate.
o Deciding between allogeneic and autologous options.
133

o Deciding between stem cell apheresis vs. bone marrow collection for
allogeneic HSCT.
o Appropriate and responsible use of supportive care services.
o Management of acute and chronic graft vs. host disease.
o Management of other transplant associated problems.
To become an effective communicator with patients and patients’ families
regarding important aspects of a solid tumor diagnosis not limited to:
o Discussing a new diagnosis.
o Delivery of “bad news.”
o Discussion of disease recurrence or progression.
o Discussion of transition to end-of-life care.
o
To become adept at the ability to communicate in a respectful and
effective manner, the treatment options appropriate for the patient’s
unique circumstance.
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
transplant patients to achieve competence in the inpatient setting.
 In their first year in the Clinics:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Oncology care. Attending MD’s will guide the
fellows during this year in the appropriate use of evidence-based
care guidelines and the literature in developing plans for their
patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
expected to develop competence in the application of their
134
supervisory skills by involvement in and overseeing the education
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
Core competencies:
Patient Care
The fellow will:
 Learn competence in an organized approach in the management of patients
undergoing hematopoietic stem cell transplantation (HSCT) with focus on:
o Determining when transplantation is appropriate
o Deciding between allogeneic and autologous options
o Deciding between stem cell apheresis vs. bone marrow collection for
allogeneic HSCT.
o Appropriate and responsible use of supportive care services
o Management of acute and chronic graft vs. host disease
 Learn competence in an ability to integrate lab clinical data, pathology
results, and radiographic data to accurately diagnose and evaluate
patients undergoing transplant and patients with transplant associated
complications.
 Learn competence in the ability to function as a member of a team to
provide appropriate support to patients undergoing transplant and patients
with transplant associated complications.
 Learn competence in the triage of night and weekend patient phone calls
providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
 Demonstrate competence in the basic knowledge of the important elements
that pertain to the need for transplantation, choice of stem cell source,
discussion of risks and benefits, fitness of the donor and patient wishes. The
fellow should assure that an H&P is dictated on all patients (whether they, the
NP, or the attending complete the task). The elements that should always be
addressed in the dictated note are:
o Rationale for transplantation.
o Any unique findings in the pre-BMT evaluation that require special
consideration.
o The choice of allogeneic vs. autologous transplant and bone marrow
vs. peripheral stem cell collection.
o The plan for GVHD prophylaxis.
o CMV status and ABO type of the donor and recipient.
o A description of risks and benefits and documentation of discussion
with patients.
135
o A determination that the allogeneic donor is eligible (or ineligible but
suitable as mentioned above).
o A specific recommendation to proceed.


Demonstrate the appropriate ordering and use of apheresis techniques,
including the indications, adverse events and safety concerns.
o The fellow will review at least two patients who require apheresis
(see separate SOP regarding apheresis education, this experience
spans the Heme, BMT, and Consult services).
Achieve competent scores on the ASH in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Demonstrate competence in actively engaging their attending MD’s to
verbalize their own unique learning needs in the pursuit of HSCT learning
specific to the patient profile to which they have been exposed.
 Demonstrate competence in actively reviewing the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Demonstrate competence in actively reflecting on their own clinical
practice in order to identify areas for improvement.
 Demonstrate competence in critically appraising the literature for given
HSCT processes and to incorporate it into their practice and decisionmaking.
 Demonstrate competence in actively describing, explaining and clarifying
a problem and identifying and incorporating new information in order to
better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians on the
UW BMT Ward service.
 Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
 Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
136

Demonstrate competence in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the second year will be competent
to obtain consent for treatment for their patient population. The
fellow will continue to discuss the encounter with the attending and
any opportunities for improvement.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively on the UW BMT Ward service with all members of the
healthcare team, and fulfill stated promises and obligations to patients and
staff (OCRN, pharmacist, scheduler, medical assistant, triage, and
patients).
 Demonstrate the ability to develop as a leader and a role-model for the
learner members of the treatment team (i.e., medical students and
residents).
 Demonstrate competence in the ability to become an effective educator of
learners on the team.
 Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Demonstrate competence in the prescription and administration of
chemotherapeutic agents.
 Demonstrate competence in the ability to work effectively on the UW BMT
Ward service with all members of the healthcare team, and fulfill stated
promises and obligations to patients (OCRN, pharmacist, scheduler,
medical assistant, triage, patients).
 Demonstrate competence in the ability to work effectively on the UW BMT
Ward service with all members of the healthcare team in the quality
improvement of care in the outpatient setting. (E.g., participation on the
Chemotherapy Council).
 Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
137
 Demonstrate competence in the ability to effectively engage personnel




and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.
Demonstrate competence in the ability to lead multidisciplinary health team
rounds.
Demonstrate competence in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Demonstrate competence in the effective triage of night and weekend patient
phone calls that results in appropriate communication to involved parties and
follow-up plans.
Demonstrate competence in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
MILESTONES--Year 3.
General Overview:
 As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of inpatient care of transplant
patients, relying on the attending for expertise and guidance.
 In their third year in the Clinics:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology care. Attending MD’s will expect the fellows during this
year to present evidence-based care guidelines from the literature
and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
learn the art of designating responsibilities for patients’ care to the
138
various team members. They will be guided in this development by
the attending MD’s.
Core competencies:
Patient Care
The fellow will:
 Apply leadership and autonomy in an organized approach in the management
of patients undergoing hematopoietic stem cell transplantation (HSCT) with
focus on:
o Determining when transplantation is appropriate
o Deciding between allogeneic and autologous options
o Deciding between stem cell apheresis vs. bone marrow collection for
allogeneic HSCT.
o Appropriate and responsible use of supportive care services
o Management of acute and chronic graft vs. host disease
 Apply leadership and autonomy in an ability to integrate lab clinical data,
pathology results, and radiographic data to accurately diagnose and
evaluate patients undergoing transplant and patients with transplant
associated complications.
 Apply leadership and autonomy in the ability to function as a member of a
team to provide appropriate support to patients undergoing transplant and
patients with transplant associated complications.
 Apply leadership and autonomy in the triage of night and weekend patient
phone calls providing medically sound and compassionate advice.
Medical Knowledge
The fellow will:
 Apply leadership and autonomy in the basic knowledge of the important
elements that pertain to the need for transplantation, choice of stem cell
source, discussion of risks and benefits, fitness of the donor and patient
wishes. The fellow should assure that an H&P is dictated on all patients
(whether they, the NP, or the attending complete the task). The elements that
should always be addressed in the dictated note are:
o Rationale for transplantation.
o Any unique findings in the pre-BMT evaluation that require special
consideration.
o The choice of allogeneic vs. autologous transplant and bone marrow
vs. peripheral stem cell collection.
o The plan for GVHD prophylaxis.
o CMV status and ABO type of the donor and recipient.
o A description of risks and benefits and documentation of discussion
with patients.
o A determination that the allogeneic donor is eligible (or ineligible but
suitable as mentioned above).
o A specific recommendation to proceed.
139


Apply leadership and autonomy in the appropriate ordering and use of
apheresis techniques, including the indications, adverse events and safety
concerns.
o The fellow will review at least two patients who require apheresis (see
separate SOP regarding apheresis education, this experience spans
the Heme, BMT, and Consult services).
Achieve competent scores on the ASH in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Apply leadership and autonomy in actively engaging their attending MD’s to
verbalize their own unique learning needs in the pursuit of HSCT learning
specific to the patient profile to which they have been exposed.
 Apply leadership and autonomy actively reviewing the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
 Apply leadership and autonomy actively reflecting on their own clinical
practice in order to identify areas for improvement.
 Apply leadership and autonomy critically appraising the literature for given
HSCT processes and to incorporate it into their practice and decisionmaking.
 Apply leadership and autonomy actively describing, explaining and
clarifying a problem and identifying and incorporating new information in
order to better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply leadership and autonomy in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Apply leadership and autonomy in the ability to effectively communicate
with patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Apply leadership and autonomy in the maintenance of an appropriate level
of professionalism with the staff, midlevel providers and physicians on the
UW BMT Ward service.
 Apply leadership and autonomy in the ability to manage areas of conflict
and to negotiate appropriate resolutions to these challenges.
 Apply leadership and autonomy in the ability to give critical and
praiseworthy feedback to subordinate learners to help those learners
along their paths.
 Apply leadership and autonomy in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
140
o It is expected that fellows during the third year will be independent
and will apply autonomous leadership to obtain consent for
treatment for their patient population. The fellow will continue to
utilize the attending MD for guidance and support.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply leadership and autonomy in the ability to work and communicate
effectively on the UW BMT Ward service with all members of the
healthcare team, and fulfill stated promises and obligations to patients and
staff (OCRN, pharmacist, scheduler, medical assistant, triage, and
patients).
 Apply leadership and autonomy in the ability to develop as a leader and a
role-model for the learner members of the treatment team (i.e., medical
students and residents).
 Apply leadership and autonomy in the ability to become an effective
educator of learners on the team.
 Apply leadership and autonomy in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
 Apply leadership and autonomy in the ability to work effectively on the UW
BMT Ward service with all members of the healthcare team, and fulfill
stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
 Apply leadership and autonomy in the ability to work effectively on the UW
BMT Ward service with all members of the healthcare team in the quality
improvement of care in the outpatient setting. (E.g., participation on the
Chemotherapy Council).
 Apply leadership and autonomy in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Apply leadership and autonomy in the ability to effectively engage

personnel and programs (i.e., nursing, social work, physical therapy, home
health care, etc.) necessary to provide optimal patient care.
Apply leadership and autonomy in the ability to lead multidisciplinary health
team rounds.
141



Apply leadership and autonomy in teaching techniques and appreciation of
educational needs of residents by providing appropriate, level-specific
didactics.
Apply leadership and autonomy in the effective triage of night and weekend
patient phone calls that results in appropriate communication to involved
parties and follow-up plans.
Apply leadership and autonomy in the ability to identify when multispecialty
consultation is necessary and foster professional relationships with clinicians
across a wide variety of specialties.
Contacts for this Rotation:
Clinic Director: Dan Mulkerin, MD. Phone: 265-8047 dm2@medicine.wisc.edu
B6/6 Director: Vicki Hubbard, RN. Phone: 265-8823
Nurse Practitioners: Linda Eckstein, NP. Phone: 263-6638
Blythe Gage, NP. Phone: 263-6638
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
142
27 April 2012
UW 1 South Park Clinical Rotation
Goals and Objectives
OVERVIEW:
The UW Hematology/Oncology Fellowship program rotates the fellows through
UW faculty outpatient clinics at 1 South Park. MD’s at that clinic care for patients
with benign and malignant hematologic problems as well as patients with a
variety of solid tumors. The clinics are organized around an attending MD with
general Hematology/Oncology focus, a nurse practitioner who is usually familiar
with the patients seen in the clinic, and several medical assistants. There is a
“triage” service operated by a rotating group of RN’s that will field outside calls
regarding laboratory values, follow-up schedules, medication refills and general
questions. Calls pertaining to new health issues will be forwarded to the
physician responsible for the patient when clinically indicated in the judgment of
the RN.
The fellows have no “On-Call” responsibilities on this rotation.
In general, this is a rotation for first year fellows, but they have the availability to
participate in this clinical rotation during all three years, depending on their goals
and career plans.
GENERAL DESCRIPTION OF RESPONSIBILITIES:
Each fellow will be assigned to an attending physician’s clinic and all patient
visits to the fellow in clinic will be staffed by that physician. The attending
physicians have clinics organized by their own clinical interests. A fellow will find
the experiences in different clinics to vary greatly with respect to the types of
diagnoses seen. The fellow may also see inpatient consults of hematology or
oncology patients at Meriter Hospital during this rotation but will not be
responsible for their daily continuous care.
The fellow should assume daily responsibility for all patients they see in their
clinic. In addition to patient encounters, the duties include: dictating all physician
visits, writing chemotherapy orders, calling patients with lab results, following up
on diagnostic tests, discussing issues with family, etc. Essentially, the fellow
should assume all responsibilities required to effectively care for the outpatient
and facilitate transitions between inpatient and outpatient care. Each patient visit
should be staffed by the attending physician. The attending should see all
patients in clinic as they are ultimately responsible for their care. All dictations
need to be co-signed by the attending. The charge codes are required to be
completed by the attending, but the fellow should discuss the various charges
143
and should be aware of the connection between the service provided and the
charges applied.
OVERALL GOALS FOR THE ROTATION:
As this is a general outpatient clinical rotation for fellows, the responsibilities are
the same as in the Hematology and Oncology continuity and non-continuity
clinics, but also overlap due to the broad nature of both hematology and
oncology diagnoses seen at this location.
Fellows are expected to achieve the milestones listed below and to show
continued growth during each month of training; expected milestones are
discussed in more detail in the following section and are broken down by year in
training.
 To become adept at:
o Forming an organized approach in the diagnosis.
o Interpretation of test results.
o Medical management of varied solid tumor diseases or hematologic
illnesses.
 To become adept at the ability to integrate clinical, radiographic, and
laboratory data to generate a differential diagnosis for a patient with a
solid tumor or hematologic illnesses.
 To become adept at the ability to use the accepted staging and
prognosticating tools available for hematologic illnesses or for solid tumor
malignancies for determining appropriate treatment.
 To become an effective communicator with patients and patients’ families
regarding important aspects of a solid tumor diagnosis not limited to:
o Discussing a new diagnosis.
o Delivery of “bad news.”
o Discussion of disease recurrence or progression.
o Discussion of transition to end-of-life care.
o
To become adept at the ability to communicate in a respectful and
effective manner, the treatment options appropriate for the patient’s
unique circumstance.
o
MILESTONES--Milestones are a general measure of a
fellow’s progress toward and beyond competency and are
not necessarily confined to a specific year in training. The
year in training model strictly serves as a baseline tool for
evaluation and comparison.
MILESTONES--Year 1.
144
General Overview:
 As a first-year learner, the fellow will work on learning the fundamentals of
Oncology and Hematology patients to achieve competence in the
outpatient setting.
 In their first year in the Clinics:
o Conditional Independence: Fellows are not expected to be
independent in their care of patients in their first year. It is during
this year that they are learning and refining the basics in order to
learn competency in Oncology and Hematology care. Attending
MD’s will guide the fellows during this year in the appropriate use of
evidence-based care guidelines and the literature in developing
plans for their patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will not have a direct supervisory role in
the teaching of subordinate learners in their first year. They are
expected to develop competence in the application of their
supervisory skills by involvement in and overseeing the education
of residents and medical students on the service under the
guidance of their attending MD’s. They will be expected to help
residents learn the methods best suited for evidence-based care
and learning.
Core competencies:
Patient Care
The fellow will:
 Learn competence in an organized approach in the medical management
of a variety of solid tumors or hematologic illnesses.
 Learn competence in an ability to integrate lab clinical data, pathology
results, and radiographic data to accurately diagnose and evaluate
patients with a solid tumor malignancy or hematologic illnesses.
 Learn competence in the prescription and administration of
chemotherapeutic agents.
 Learn competence in recognizing and understanding the side effect
profiles of various chemotherapeutic agents.
 Learn competence in the performance of appropriate hematology or
oncology-based procedures; e.g., intrathecal chemotherapy administration
or bone marrow evaluation.
 Learn competence in the ability to function as a member of a team to
provide appropriate support to patients with solid tumors or hematologic
illnesses.
145
Medical Knowledge
The fellow will:
 Demonstrate competence in the ability to describe the basic principles of a
variety of oncologic neoplasms or hematologic illnesses and learn to
effectively use this knowledge to come up with an evidence-based
treatment plan, searching sources for evidence to support the fellow’s
decision.
 Demonstrate competence in the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies or hematologic
illnesses for determining appropriate treatment.
 Demonstrate competence in the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will learn how to practice reflective self-improvement by:
 Actively engaging their attending MD’s to verbalize their own unique
learning needs in the pursuit of oncologic and hematologic learning
specific to the patient profile to which they have been exposed.
 Actively reviewing the electronic notes the fellow has written with the
attending physician to ensure they are complete, accurate, and entail a
thorough plan of care.
 Actively reflecting on their own clinical practice in order to identify areas
for improvement.
 Critically appraising the literature for a given solid tumor or hematologic
illnesses and to incorporate it into their practice and decision-making.
 Actively describing, explaining and clarifying a problem and identifying and
incorporating new information in order to better optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Demonstrate competence in the ability to interact in an appropriate
therapeutic relationship with patients and families.
 Demonstrate competence in the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
 Demonstrate competence in the maintenance of an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
UWCCC 1 South Park clinic.
146



Demonstrate competence in the ability to manage areas of conflict and to
negotiate appropriate resolutions to these challenges.
Demonstrate competence in the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
Demonstrate competence in the ability to satisfactorily discuss a
chemotherapy treatment plan with a patient incorporating the process of
informed consent.
o It is expected that fellows during the first year will regularly be
observed and the encounter evaluated by the attending MD in
which the fellow obtains consent for treatment. After the
observation, the fellow should discuss with the attending the
encounter and any opportunities for improvement. These
encounters will be evaluated at the end of a 6 month period.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Demonstrate competence in the ability to work and communicate
effectively in the UWCCC 1 South Park outpatient clinic with all members
of the healthcare team, and fulfill stated promises and obligations to
patients and staff (OCRN, pharmacist, scheduler, medical assistant,
triage, and patients).
 Demonstrate the ability to develop as a leader and a role-model for the
learner members of the treatment team (i.e., medical students and
residents).
 Demonstrate competence in the ability to become an effective educator of
learners on the team.
 Demonstrate competence in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Demonstrate competence in the prescription and administration of
chemotherapeutic agents.
 Demonstrate competence in the ability to work effectively in the outpatient
clinic with all members of the healthcare team, and fulfill stated promises
and obligations to patients (OCRN, pharmacist, scheduler, medical
assistant, triage, patients).
 Demonstrate competence in the ability to work effectively in the outpatient
clinic with all members of the healthcare team in the quality improvement
of care in the outpatient setting. (E.g., participation on the Chemotherapy
Council).
147


Demonstrate competence in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
Demonstrate competence in the ability to effectively engage personnel
and programs (i.e., nursing, social work, physical therapy, home health
care, etc.) necessary to provide optimal patient care.
MILESTONES BY YEAR OF TRAINING--Year 2.
General Overview:
 As a second year learner, the fellow will work on applying the
fundamentals of outpatient care of Oncology and Hematology patients.
 In their second year in the Clinics:
o Conditional Independence: Fellows are expected to be learning
more independence in their care of patients in their second year,
but still under the supervision of their attending MD’s. During this
year that they are applying the skills learned in their first year
towards more advanced Oncology and Hematology care. Attending
MD’s will expect the fellows during this year to present evidencebased care guidelines from the literature before developing plans
for their patients’ care.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will begin to have a more direct
supervisory role in their second year. They are expected to begin to
apply their supervisory skills and direct the education of residents
and medical students on the service. They will be expected to help
residents learn the methods best suited for evidence based care
and learning which they themselves learned in their first year of
fellowship. They will be guided in this development by the attending
MD’s.
Core competencies:
Patient Care
The fellow will be able to:
 Apply expertise to an organized approach in the medical management of a
variety of solid tumors or hematologic illnesses.
 Apply expertise to an ability to integrate lab clinical data, pathology results,
and radiographic data to accurately diagnose and evaluate patients with a
solid tumor malignancy or hematologic illness.
 Apply expertise to competence in the prescription and administration of
chemotherapeutic agents.
148



Apply expertise to competence in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
Apply expertise to competence in the performance of appropriate
oncology or hematology based procedures; e.g., intrathecal chemotherapy
administration or bone marrow evaluation.
Apply expertise to the ability to function as a member of a team to provide
appropriate support to patients with solid tumors or hematologic illnesses.
Medical Knowledge
The fellow will:
 Apply expertise to describe the basic principles of a variety of oncologic
neoplasms or hematologic illnesses and learn to effectively use this
knowledge to come up with an evidence-based treatment plan, searching
sources for evidence to support the fellow’s decision.
 Apply expertise to the ability to use the accepted staging and
prognosticating tools available for oncologic malignancies or hematologic
illnesses for determining appropriate treatment.
 Apply expertise to the ability to perform self-directed enhancement of their
medical knowledge through the use of textbooks, journals and appropriate
medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will:
 Apply expertise to actively engage their attending MD’s to verbalize their
own unique learning needs in the pursuit of oncologic or hematologic
learning specific to the patient profile to which they have been exposed.
 Apply expertise to review the electronic notes the fellow has written with
the attending physician to ensure they are complete, accurate, and entail
a thorough plan of care.
 Apply expertise to demonstrate the ability to reflect on their own clinical
practice in order to identify areas for improvement.
 Apply expertise to demonstrate the capability to critically appraise the
literature for a given solid tumor or hematologic illnesses and to
incorporate it into their practice and decision-making.
 Apply expertise to demonstrate the ability to describe, explain and clarify a
problem and to identify and incorporate new information to optimize
patient care.
Interpersonal and Communication Skills
The fellow will:
149






Apply expertise to demonstrate the ability to interact in an appropriate
therapeutic relationship with patients and families.
Apply expertise to demonstrate the ability to effectively communicate with
patients regarding all aspects of their care including a new diagnosis,
relapse or transition to end-of-life care.
Apply expertise to maintain an appropriate level of professionalism with
the staff, midlevel providers and physicians in the UWCCC 1 South Park
clinic.
Apply expertise to demonstrate the ability to manage areas of conflict and
to negotiate appropriate resolutions to these challenges.
Apply expertise to demonstrate the ability to give critical and praiseworthy
feedback to subordinate learners to help those learners along their paths.
Apply expertise to satisfactorily discuss a chemotherapy treatment plan
with a patient incorporating the process of informed consent.
o It is expected that fellows during the second year will be competent
to obtain consent for treatment for their patient population. The
fellow will continue to discuss the encounter with the attending and
any opportunities for improvement.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply expertise in the ability to work and communicate effectively in the
outpatient clinic with all members of the healthcare team, and fulfill stated
promises and obligations to patients and staff (OCRN, pharmacist,
scheduler, medical assistant, triage, and patients).
 Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
 Apply expertise in the ability to become an effective educator of learners
on the team.
 Apply expertise in the ability to be on time and attend all required
meetings, clinic start times and other extended learning opportunities.
Systems-Based Practice
The fellow will:
 Apply expertise in the prescription and administration of chemotherapeutic
agents.
 Apply expertise in the ability to work effectively in the UWCCC 1 South
Park outpatient clinic with all members of the healthcare team, and fulfill
stated promises and obligations to patients (OCRN, pharmacist,
scheduler, medical assistant, triage, patients).
150



Apply expertise in the ability to work effectively in the outpatient clinic with
all members of the healthcare team in the quality improvement of care in
the outpatient setting. (E.g., participation on the Chemotherapy Council).
Apply expertise in the understanding of a patient's unique circumstances
with respect to their health care coverage and system of health care
provision. (E.g. applies cost-effective strategies to patient care while
advocating for quality care).
Apply expertise in the ability to effectively engage personnel and programs
(i.e., nursing, social work, physical therapy, home health care, etc.)
necessary to provide optimal patient care.
MILESTONES BY YEAR OF TRAINING--Year 3.
General Overview:
 As a third year learner, the fellow will have a virtually independent
approach on applying the fundamentals of outpatient care of Oncology
and Hematology patients, relying on the attending for expertise and
guidance.
 In their third year in the Clinics:
o Conditional Independence: Fellows are expected to be functioning
as the independent team leader during this year. They should be
directing the team in terms of developing plans of care, and
designation of responsibilities. During this year that they are
applying the skills learned in their first two years towards advanced
Oncology and Hematology care. Attending MD’s will expect the
fellows during this year to present evidence-based care guidelines
from the literature and a fully-developed care plan for their patients.
 Evaluators will use the appropriate, focused evaluation tools
to assess competency and continued progress beyond
competency as a means to assign conditional
independence.
o Supervisory Role: Fellows will have an independent supervisory
role in their third year. They are expected to apply their supervisory
skills and direct the education of residents and medical students on
the service. They will be expected not only to help residents learn
the methods best suited for evidence based care and learning
which they themselves learned in their first year of fellowship, but
also to begin to teach the residents themselves how to become
educators. They will also be expected to have more of a
supervisory role for the Mid-level providers on the service and to
learn the art of designating responsibilities for patients’ care to the
various team members. They will be guided in this development by
the attending MD’s.
Core competencies:
151
Patient Care
The fellow will be able to:
 Apply leadership and autonomy to an organized approach in the medical
management of a variety of solid tumors or hematologic illnesses.
 Apply leadership and autonomy to an ability to integrate lab clinical data,
pathology results, and radiographic data to accurately diagnose and
evaluate patients with a solid tumor malignancy or hematologic illness.
 Apply leadership and autonomy to competence in the prescription and
administration of chemotherapeutic agents.
 Apply leadership and autonomy in recognizing and understanding the side
effect profiles of various chemotherapeutic agents.
 Apply leadership and autonomy in the performance of appropriate
oncology or hematology based procedures; e.g., intrathecal chemotherapy
administration or bone marrow evaluation.
 Apply leadership and autonomy in the ability to function as a member of a
team to provide appropriate support to patients with solid tumors or
hematologic illnesses.
Medical Knowledge
The fellow will:
 Apply leadership and autonomy to describe the basic principles of a
variety of oncologic neoplasms or hematologic illnesses and learn to
effectively use this knowledge to come up with an evidence-based
treatment plan, searching sources for evidence to support the fellow’s
decision.
 Apply leadership and autonomy to the ability to use the accepted staging
and prognosticating tools available for oncologic malignancies or
hematologic illnesses for determining appropriate treatment.
 Apply leadership and autonomy to the ability to perform self-directed
enhancement of their medical knowledge through the use of textbooks,
journals and appropriate medical search engines such as PubMed.
 Achieve competent scores on the ASCO in-training exam for their level of
training (given in February of each year) and demonstrate continued
improvement over each of their 3 years in training.
Practice-Based Learning and Improvement
The fellow will:
 Apply leadership and autonomy to actively engage their attending MD’s to
verbalize their own unique learning needs in the pursuit of oncologic or
hematologic learning specific to the patient profile to which they have been
exposed.
 Apply leadership and autonomy in the review of the electronic notes the
fellow has written with the attending physician to ensure they are
complete, accurate, and entail a thorough plan of care.
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Apply leadership and autonomy to demonstrate the ability to reflect on
their own clinical practice in order to identify areas for improvement.
Apply leadership and autonomy to demonstrate the capability to critically
appraise the literature for a given solid tumor and to incorporate it into
their practice and decision-making.
Apply leadership and autonomy to demonstrate the ability to describe,
explain and clarify a problem and to identify and incorporate new
information to optimize patient care.
Interpersonal and Communication Skills
The fellow will:
 Apply leadership and autonomy to demonstrate the ability to interact in an
appropriate therapeutic relationship with patients and families.
 Apply leadership and autonomy to demonstrate the ability to effectively
communicate with patients regarding all aspects of their care including a
new diagnosis, relapse or transition to end-of-life care.
 Apply leadership and autonomy to maintain an appropriate level of
professionalism with the staff, midlevel providers and physicians in the
UWCCC 1 South Park clinic.
 Apply leadership and autonomy to demonstrate the ability to manage
areas of conflict and to negotiate appropriate resolutions to these
challenges.
 Apply leadership and autonomy to demonstrate the ability to give critical
and praiseworthy feedback to subordinate learners to help those learners
along their paths.
 Apply leadership and autonomy to satisfactorily discuss a chemotherapy
treatment plan with a patient incorporating the process of informed
consent.
o It is expected that fellows during the third year will be independent
and will apply autonomous leadership to obtain consent for
treatment for their patient population. The fellow will continue to
utilize the attending MD for guidance and support.
o See UWHC Administrative Policy 4.17 regarding informed consent,
and for a review, visit the UVA tutorial.
Professionalism
The fellow will:
 Apply leadership and autonomy in the ability to work and communicate
effectively in the UWCCC 1 South Park outpatient clinic with all members
of the healthcare team, and fulfill stated promises and obligations to
patients and staff (OCRN, pharmacist, scheduler, medical assistant,
triage, and patients).
 Continue to develop as a leader and a role-model for the learner members
of the treatment team (i.e., medical students and residents).
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Apply leadership and autonomy in the ability to become an effective
educator of learners on the team.
Apply leadership and autonomy in the ability to be on time and attend all
required meetings, clinic start times and other extended learning
opportunities.
Systems-Based Practice
The fellow will:
 Apply leadership and autonomy in the prescription and administration of
chemotherapeutic agents.
 Apply leadership and autonomy in the ability to work effectively in the
outpatient clinic with all members of the healthcare team, and fulfill stated
promises and obligations to patients (OCRN, pharmacist, scheduler,
medical assistant, triage, patients).
 Apply leadership and autonomy in the ability to work effectively in the
UWCCC 1 South Park outpatient clinic with all members of the healthcare
team in the quality improvement of care in the outpatient setting. (E.g.,
participation on the Chemotherapy Council).
 Apply leadership and autonomy in the understanding of a patient's unique
circumstances with respect to their health care coverage and system of
health care provision. (E.g. applies cost-effective strategies to patient care
while advocating for quality care).
 Apply leadership and autonomy in the ability to effectively engage
personnel and programs (i.e., nursing, social work, physical therapy, home
health care, etc.) necessary to provide optimal patient care.
Contacts for this Rotation:
Clinic Director: Dan Mulkerin, MD. Phone: 265-8047 dm2@medicine.wisc.edu
UWCCC 1 SP Clinic Director: David Hei, MD MD. Phone: 287-2552 david.hei@uwmf.wisc.edu
Fellowship Director: Thomas McFarland. Phone 265-3890 tmcfarland@medicine.wisc.edu
Program Coordinator: Deana Grade. Phone: 263-4459 dsg@medicine.wisc.edu
Clinic Manager: Julie Nampel, R.N. 287-2188
Chemo Coordinator: Susan Antonie, R.N. 287-3512
Other Info: Appointment Desk: 287-2552
Clinic Nurses Station: 287-2229
Nurse Triage 287-2314
Pharmacy 287-2995
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